Nursing Week 6_Assignment_DNP 860

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Implementing the Summary of Diabetes Self-Care Activities (SDSCA) Tool to Improve Self-Management in Adults with Type 2 Diabetes.

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Introduction

One of the most serious chronic diseases among adults in the United States and the entire world is type 2 diabetes mellitus (T2DM). The process of diabetes management presupposes the uninterrupted use of self-care habits including blood sugar monitoring, adherence to dietary practices, physical activity, taking medications as prescribed, and proper foot care. Very poor glycemic control in diabetes patients is still being seen even with the use of advanced treatment and management interventions because of poor adherence to the prescribed self-management strategies. Activists and stakeholders in healthcare are now becoming more sensitive to the fact that empowering patients through organized instruments and training is crucial to enhance their self-care habits.

Evidence-based practice (EBP) and quality improvement (QI) programs are needed to fill the gaps between junction of what should happen and what is actually happening with patients in clinical environments. The Summary of Diabetes Self-Care Activities (SDSCA) is one of the evidence-based instruments that can be used to measure and provide support regarding diabetes self-management. In addition, the SDSCA is a valid, self-reported instrument that evaluates the levels of adherence to key diabetes self-management behaviors, which enables health professionals to understand the aspects in which intervention and assistance are needed.

This quality improvement project will address the implementation of the evidence-based SDSCA tool to enhance the diabetes self-care behaviors of adults with type 2 diabetes. The following paper will discuss the background of the clinical problem, give a succinct problem statement, and give a PICOT question that will direct the creation of this evidence-based intervention.

Background

Diabetes type 2 is a long-term metabolic disorder that is associated with insulin resistance and impaired insulin production leading to the high level of glucose in blood. Centers for Disease Control and Prevention (CDC) reveal that over 37 million Americans are diabetic, most of them being type 2 diabetes (CDC, 2023). When diabetes is not well controlled, it can cause extreme complications such as cardiovascular disease, kidney failure, neuropathy, retinopathy, and amputation of lower limbs. Such complications are leading to a much lower quality of life and have a major contribution to the high cost of health care.

Patient involvement in self-management activities on a daily basis is a major element of effective management of diabetes. Self-management of diabetes involves observing the levels of blood sugar, taking medication on time, maintaining proper diets, physical exercises, and taking care of the feet. The studies also show that regular practices of these activities can substantially enhance glycemic control and minimize diabetes-related complications (Chrvala et al., 2021).

Although benefits of diabetes self-management have been well documented, advantageous practices are often inconsistent among patients. The reasons that lead to poor adherence are lack of health literacy, no education on diabetes care, lack of support by healthcare providers, and socioeconomic factors. In cases when they fail to properly cope with the condition, there is a high likelihood of the development of complications, which further stresses healthcare systems and lowers the well-being of patients (Powers et al., 2022).

Education, monitoring, and behavioral interventions should be among healthcare providers as essential tools to assist patients in self-management. Evidence-based assessment tools may be used to assist clinicians in determining lapses in self-care practices and specific intervention to address the needs of each patient. The Summary of Diabetes Self-Care Activities (SDSCA) is one such instrument. The SDSCA is a validated and popular self-report measure assessing the essential self-management behavioral patterns of diabetes in the last seven days. The instrument assesses a variety of areas such as a diet, physical activity, blood glucose testing, medication compliance, and foot care (Toobert et al., 2021).

SDSCA tool has been applied widely both in the research and clinical practice in order to assess the behavior of self-management in diabetic patients and implement the necessary interventions. It was demonstrated in the studies that the integration of structured self-care assessment instruments into an everyday clinical routine will enhance the awareness that patients have regarding their practices and enable medical personnel to offer personalized feedback and assistance (Shrivastava et al., 2021). Clinicians can use the identification of certain self-care deficits to apply such interventions as patient education, lifestyle counseling, and behavioral support strategies.

Besides enhancing patient outcomes, the application of systematic self-care assessment tools in addition to the principles of evidence based practice and quality improvement. Evidence-based practice is a practice that incorporates the most suitable evidence in healthcare practices with clinical expertise and patient interests to make healthcare outcomes better (Schmidt and Brown, 2021). Quality improvement initiatives aim at improving on the systematic closing of the gaps between the suggested practices and the real care delivery.

The AHRQ Gap Analysis Toolkit is a systematic method of gap identification and management of clinical practice. Gap analysis assists healthcare institutions in recognizing the discrepancy between the practice and evidence-based standard practices. Within the context of diabetes management, the gap in the clinical practice of assessing patient self-management behavior and continuously monitoring it through the use of standardized instruments is observed to be missing. Clinicians at risk of missing the behaviors that lead to poor glycemic control may be unable to assess the self-management practices systematically.

The use of the SDSCA tool would be a viable approach to take care of this gap. Through regular evaluation of the self-management of diabetes, medical professionals will be able to determine the points where patients need further assistance or training. This will facilitate patient involvement, improve interactions between patients and providers and facilitate the creation of personalized care plans.

All in all, in healthcare, the enhancement of diabetes self-management is an acute concern. The use of evidence-based tools like the SDSCA will help gain insight into patient actions and tailor specific interventions to support the better results. The strategy of filling the gap in systematic self-care evaluation with the use of the SDSCA tool can result in the enhancement of self-management practices, improved glycemic control, and decreased complications in adults with type 2 diabetes.

Problem Statement

Type 2 diabetes is a major health issue of concern to the population considering its prevalence and serious complications in case of inadequate management of the disease. Management of diabetes demands patients to participate in daily self-management responsibilities such as maintaining healthy diets, physical exercise, blood sugar monitoring, medication adherence, and proper foot care. Nonetheless, such behavioral patterns cannot always be sustained among many adults with type 2 diabetes and result in poor glycemic regulation and the development of complications.

Healthcare providers in most clinical environments have been more concerned with medical treatment, which is the prescription of drugs, but not much attention is paid to the evaluation and encouragement of patient self-care practices. In the absence of formal evaluation instruments, clinicians will not have an understanding of the daily patterns that determine how patients can effectively cope with the condition. There is therefore a chance to offer special education and support that is usually overlooked.

The effects of a low self-management of diabetes are major. Poor glycemic control is a factor that results in inadequate self-care behaviors, leading to the development of complications like cardiovascular disease, kidney disease, nerve damage and impaired vision. Hospitalization, disability, and the reduction of the quality of life can be the results of these complications. Also, the economic cost of diabetes complications imposes a great pressure on healthcare systems and society (Powers et al., 2022).

The absence of uniform tools that are consistently applied in clinical practice to assess the behavior of patient self-care is another important concern. Despite the existence of a number of validated tools, these tools are not widely used by many healthcare providers when assessing patients. Lack of systematic assessment restricts the capacity of healthcare providers to discover gaps in patient behaviors and make proper interventions.

The introduction of the Summary of Diabetes Self-Care Activities (SDSCA) tool is one of the evidence-based solutions to this problem. The SDSCA is a reliable tool, which assesses compliance on basic self-management behavior requirements in diabetes; it gives relevant information to healthcare givers on how patients handle it. The application of the SDSCA in clinical practice can enable clinicians to understand particular areas of concern in patients that need more support and education or behavioral interventions.

The absence of bridging the gap in the evaluation of diabetes self-management practices can lead to the further worsening of disease control and complications prevalence among type 2 diabetes patients. Absent targeted interventions, patients are likely to be oblivious of the value of self-management behaviors or have resources needed to enhance their behaviors.

The purpose of this quality improvement project is to fill this clinical gap by bringing the SDSCA tool to systematically monitor and enhance the self-management behaviors of diabetes in patients with type 2 diabetes. When clinical practice is combined with the evidence-based assessment tool, healthcare providers will be in a better position to determine the areas that are in need of intervention, as well as, create a personalized approach to helping patients self-manage. The end result of this project is to enhance patient outcomes by enhancing behaviors that are effective in diabetes self-management.

Proposed PICOT

Population (P)

The group to be used in this project consists of adults with type 2 diabetes who are treated in a clinical facility. Adult type 2 diabetes patients should receive continuous education and care to control their illness. This population is suitable since the behaviors of self-management of diabetes play a significant role in the outcomes of the disease and the rate of complication.

Intervention (I)

The change initiative in this project will be the application of the Summary of Diabetes Self-Care Activities (SDSCA) tool. SDSCA is a questionnaire that has been proved and is applied to assess diabetic self-management behaviors including adherence to diet, exercise, monitoring of blood glucose, medication adherence and foot care. The tool will be incorporated in the regular patient assessment to determine areas that need more education or assistance to the patients.

Comparison (C)

The comparison group will entail the existing standard practice in the absence of the systematic application of SDSCA tool. In most clinical practices, the healthcare professionals are not using a standardized assessment tool but instead opt to discuss the self-care behavior with the patients in general. The same will be done in terms of comparing the results of routine care and SDSCA-guided assessment to identify the effectiveness of an intervention.

Outcome (O)

It is anticipated that this project will result in a better performance of diabetes self-management practices in type 2 diabetes adults. The use of better self-management practices can result in improved glycemic control, higher levels of patient awareness of self-management activities, and lower risks of diabetes-related complications.

Time (T)

This project has a general duration of three to six months after the inculcation of SDSCA tool. This will be the time to assess the shift in the self-care behaviors of patients and the success of the intervention.

PICOT Question

How the application of the Summary of Diabetes Self-Care Activities (SDSCA) tool (I) versus standard care with no structured self-care assessment (C) in type 2 diabetes (P) patients in relation to diabetes self-care behaviors (O) in three months (T)?

Conclusion

Type 2 diabetes is still a major challenge to patients and health care systems; it is complicated with high chances of complications. Management of diabetes involves continuous self-care practices but most of the patients do not manage to adhere to the practices. There is a knowledge gap in clinical practice when clinicians fail to routinely evaluate and reinforce patient self-management practices with the help of structured tools.

The Summary of Diabetes Self-Care Activities (SDSCA) instrument provides an empirically supported means of assessments of patient compliance with the most important diabetes self-management practices. The application of this tool in the clinic can assist the health professionals in recognizing the gaps in the practices of the patients and offer specific education and assistance. By covering these gaps, healthcare professionals are capable of enhancing self-management, glycemic control, and decreased complications in a population with type 2 diabetes.

This quality improvement project will recommend the adoption of SDSCA tool to improve the self-care behavior of adults with diabetes type 2. By relying on evidence-based practice and guided evaluation instruments, healthcare professionals will be able to assist patients on a more constructive level and help to improve the quality of their health outcomes.

References

Centers for Disease Control and Prevention. (2023). National diabetes statistics report 2023. U.S. Department of Health and Human Services.

Chrvala, C. A., Sherr, D., & Lipman, R. D. (2021). Diabetes self-management education for adults with type 2 diabetes mellitus. Patient Education and Counseling, 104(1), 11-21.

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M., Fischl, A., ... & Vivian, E. (2022). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report. The Diabetes Educator, 48(4), 350-369.

Schmidt, N. A., & Brown, J. M. (2021). Evidence-based practice for nurses: Appraisal and application of research (5th ed.). Jones & Bartlett Learning.

Shrivastava, S. R., Shrivastava, P. S., & Ramasamy, J. (2021). Role of self-care in management of diabetes mellitus. Journal of Diabetes & Metabolic Disorders, 20(1), 1-6

Toobert, D. J., Hampson, S. E., & Glasgow, R. E. (2021). The Summary of Diabetes Self-Care Activities measure. Diabetes Care, 44(3), 943-950.