CLC – Evidence-Based Practice Project: Intervention on Diabetes

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Introduction

Older adults are at a high risk of developing chronic illnesses, especially because of their age and reduced physical activity, which results in poor weight management and lifestyle practices. According to LeRoith et al. (2019), diabetes is a common disease among individuals aged 65 years and over. Due to the increasing population of the elderly with diabetes, there is a need to develop evidence-based actions to manage the disease. These interventions should be developed, considering the needs of these patients. For example, smartphone use in the self-management of some conditions has been a common practice in many healthcare settings. These gadgets are equipped with android applications to allow patients to enter their medical data and interact with care providers for close monitoring of disease symptoms.

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Older Adult Self-Efficacy Study of Mobile Phone Diabetes Management

The aim of this study was to evaluate how effective mobile intervention is in the management of diabetes. Quinn et al. (2016) wanted to explore an alternative approach to self-monitoring and diabetes management among older adults. Older adults are exposed to multiple chronic illnesses, and it is important to ensure they are better positioned to manage these diseases. The reason Quinn et al. (2016) chose diabetes is that serious complications are associated with diabetes. Some of them include cognitive and functional impairment, hand and feet neuropathies, falls and consequent fractures, myocardial infarctions, lower-extremity amputations, falls, and consequent fractures (Quinn et al., 2016). As such, developing effective self-management interventions is necessary to ensure improved diabetes management self-efficacy among older adults.

The Intervention Tool

The intervention tool identified by the research is mobile phone health intervention. The researchers recruited eligible older adults with diabetes and enrolled them in a personalized patient Internet Web portal. They were then instructed to use mobile phones to enter their blood glucose data into this portal. They were then sent educational information and automatic messages to help them manage their diabetes. Some of the measures included blood glucose measurements, self-efficacy, and perception of their energy. All these measures were reported following some guidelines and recommendations as determined by the participants’ primary care physicians.

The Specific Patient Population Used in the Study

This study’s convenience sample was 7 older adults, aged 65 and above, who had Type 2 diabetes and were in community-based care under the watch of their primary care physicians. They were also English speaking since the intervention was administered in the English language. Moreover, these patients did not have any cognitive impairment as that would bar them from using the intervention tool, thereby affecting the study findings’ credibility. Also, those on oral antihyperglycemic medications were eligible to participate in the study. Physicians identified and recruited 18 people to the study, but 8 were eligible. However, one dropped before being trained on the use of mobile phone intervention in the management of diabetes due to consent. Their mean age was 70.3 years, and three were male while four were female; 4 were black while 3 were white.

Research Results

Participants were able and willing to use the web portal and smartphones to input their diabetes management information, including blood sugar data. There was a significant increase in their self-efficacy scores concerning the management of diabetes from 7.7 at baseline to 8.0 at the end of the study (Quinn et al., 2016). Moreover, this increase in self-efficacy levels indicated that smartphones and mobile phones could be useful tools for improving diabetes self-management. Besides, older adults recorded a positive attitude towards this intervention tool after having been trained to use it and find it easy to manage their diabetes. Therefore, using mobile health interventions to manage diabetes among older adults is an effective tool that can be integrated into nursing practice.

Participants’ Baseline Diabetes Stages of Change

Participants were ready and willing to use the web portal and smartphones to input their diabetes management information, including blood sugar data. There was a significant increase in their self-efficacy scores concerning the management of diabetes from 7.7 at baseline to 8.0 at the end of the study (Quinn et al., 2016). Moreover, this increase in self-efficacy levels indicated that smartphones and mobile phones could be useful tools for improving diabetes self-management. Besides, older adults recorded a positive attitude towards this intervention tool after having been trained to use it and find it easy to manage their diabetes. Therefore, using mobile health interventions to manage diabetes among older adults is an effective tool that can be integrated into nursing practice.

The Main Idea of the Research Findings for Older Adults

The smartphone-based technological intervention has been found to be effective in managing diabetes and many other chronic illnesses. The basis of this intervention is a secure data-based information sharing system among physicians, automated feedback from physicians based on patients’ blood glucose levels patterns. The study found out that there were positive outcomes in diabetes health, including hypo- and hyperglycemia rates and HbA1c levels. The population of older adults with diabetes is increasing. This trend calls for the need to capitalize on smartphone-based tools to help them self-manage the disease and communicate with their care providers to improve their quality of life. From the research findings, the average scale for the participants’ readiness to use this mobile intervention tool was 9/5 out of 10, while their confidence to self-monitor diabetes was 9.8. For these reasons, it was evident that older adults with diabetes are very willing, ready, and confident to use a mobile intervention to manage their illness. Also, the self-efficacy level was 7.7 at baseline, but at the end of the study, it increased to 8.0. these statistics indicate that mobile intervention for diabetes management is clinically relevant to diabetes and nursing practice and should be adopted widely. As such, this intervention should be adopted to manage all other populations with diabetes and other chronic illnesses.

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Importance of Psychological and Cultural Aspects in Diabetes Care

According to Chew et al. (2015), diabetes patients need psychological support throughout their life. A patient who has been diagnosed with diabetes experiences a decline in their psychological stability. Chew et al. (2015) report that about 40% of these patients acknowledge that diabetes has a significant adverse effect on their quality of life since the medication does not allow them to continue living a normal life. Thus, it is important to consider the psychological aspect when designing a plan of care for a patient diagnosed with diabetes. In minority ethnic communities, diabetes is very prevalent (Caballero, 2018). This group often receives suboptimal care, which leads to adverse health outcomes regarding the management of diabetes. Therefore, the nursing staff must adopt acculturation in their treatment plan to ensure that they incorporate mainstream cultural aspects when treating diabetes patients from culturally diverse backgrounds. Hence, nurses need to be culturally aware of the patient’s culturally driven beliefs and behaviors when designing a plan of care (Caballero, 2018). There should be good patient-provider communication to ensure effective self-care behaviors.

Importance of Spiritual Aspects in Diabetes Care

Spirituality plays a significant role in disease management among certain populations. Spiritual aspects are important since the quality of life and medication receptivity are related to religiosity or spirituality (Darvyri et al., 2018). There is a high level of spirituality among low socioeconomic status people, which triggers their low levels of depression and stress. According to Darvyri et al. (2018), these people usually have greater control over their diabetes. Spirituality imparts an altruistic approach to disease management among these people, which improves the management of diabetes due to reduced stress levels. Also, Darvyri et al. (2018) report that spirituality enhances a person’s coping skills in stressful events, including diseases. Thus, it is vital to consider the spiritual aspect when designing a diabetes patient care plan.

How Support can be Offered in These Respective Areas as Part of a Plan of Care

Patients with diabetes have many psychological needs that need to be addressed to improve their quality of life and receptivity to treatment. Kalra et al. (2018) suggest that positive psychology interventions can help boos the psychological wellbeing of diabetes patients. Examples of psychological support which can be offered to these patients include gratitude letters and acts of kindness. This support aims to decrease the risk of depression and improve their wellbeing (Kalra et al., 2018). Therefore, positive psychology-based exercises can help provide psychological support to a diabetes patient.

How Support can be Offered in These Respective Areas as Part of a Plan of Care cont.

It is important to be sensitive to the cultural needs of a diabetes client. An example of avoiding cultural barriers is through effective communication (Zeh et al., 2016). It is important to consider the level of education and health literacy levels when offering cultural support to the client. An example of offering support to those clients with low literacy is to utilize professional interpreters to help translate all the medical procedures and interventions effectively. Also, the nurse can use tailored diabetes education to meet the needs of the clients (Zeh et al., 2016). Examples of doctored education are by using a teach-back approach and illustrated graphics to confirm the patient is understanding. This education can be accompanied by culturally sensitive information to ensure efficient diabetes management. Therefore, the ability to communicate effectively cross-culturally is essential in providing cultural support to a diabetes client.

How Support can be Offered in These Respective Areas as Part of a Plan of Care cont.

Before any medical intervention, the healthcare professional should assess the client’s religious values and beliefs and be aware of the various religious beliefs among the population being served. For example, Hispanics like praying before starting many activities, and it is important to allow them to do that. Also, Rebolledo and Arellano (2016) note that spirituality plays a significant role in disease management, especially for those people with low socioeconomic status. For example, Hispanics believe that prayers have a profound impact on the management of their illnesses, and they view it as a spiritual intervention. Besides, they take it as a coping strategy once diagnosed with chronic illnesses such as diabetes (Rebolledo & Arellano, 2016). Spirituality also plays a significant role in changing unhealthy behaviors among this population. As such, it is important for the nurse to take a few minutes to pray with them to ensure they are well prepared and ready to start diabetes medication, for instance, insulin initiation. On the other hand, Muslims view fasting as a spiritual intervention, as Rebolledo and Arellano (2016) state. Since this practice can affect their decisions about insulin therapy, it is necessary for the nurse to discuss with the client how best to balance between medications and their religious obligations. It is vital for the nurse to combine medical guidelines with education for enhanced clients’ health literacy is and improved health outcomes from effective diabetes management.

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How the New Tool Can be Integrated into Nursing Practice

Through mHealth, mobile phones and smartphones can help health care professionals (HCPs) share information regarding many health conditions with their patients and other HCPs. Physicians can also offer such services as remote monitoring, education, and direct care (Doupis et al., 2020). This approach is of particular significance in the management of diabetes since there is a need for strict adherence to care regimens such as secondary preventive testing, medications, and monitoring of blood glucose levels. The use of mobile health interventions can help to address the widespread poor medication adherence among diabetes patients with improved disease management options (Doupis et al., 2020). Therefore, considering diabetes is a chronic illness that requires close monitoring and management, the adoption of mobile health interventions will be a handy approach. Moreover, an essential part of clinicians’ orientation should be on mobile interventions because of their potential to transform the management of disease, especially the chronic ones (Luo & White-Means, 2018). For example, from the above study, it was evident that smartphone-based technologies and tools present a promising opportunity to improve self-care and diabetes management among older adults. Lastly, mobile intervention devices can be installed at the points of care to improve the self-monitoring and communication between physicians and their patients. Some of these devices can allow for video conferencing, email, text, and video calling, thereby improving communication capabilities. Also, nurses can benefit from the clinical software applications installed on smartphones, including medical calculators and disease diagnosis aids. Therefore, this new tool can be integrated into the nursing practice to perform such functions as medical education, reference and information gathering, communications and consulting, and health record maintenance and access.

Conclusion

Owing to the high prevalence of diabetes, especially among older adults, there is a need to build on evidence-based interventions to help manage the disease. Many applications have been developed to allow diabetes patients to self-manage their blood sugar levels with a healthcare professional’s virtual help. From this study, it has been shown that this intervention is a promising approach to improve the health of people with this chronic illness. However, there is a need for improved interactivity of these applications to consider using this approach to manage other chronic diseases.

References

Caballero A. E. (2018). The “A to Z” of managing type 2 diabetes in culturally diverse populations. Frontiers in Endocrinology, 9, 479.

Chew, B. H., Shariff-Ghazali, S., & Fernandez, A. (2015). Psychological aspects of diabetes care: Effecting behavioral change in patients. World Journal of Diabetes, 5(6), 796–808.

Darvyri, P., Christodoulakis, S., Galanakis, M., Avgoustidis, A. G., Thanopoulou, A., & Chrousos, G. P. (2018). On the role of spirituality and religiosity in type 2 diabetes mellitus management—A systematic review. Psychology, 9(4), 728-744.

Doupis, J., Festas, G., Tsilivigos, C., Efthymiou, V., & Kokkinos, A. (2020). Smartphone-based technology in diabetes management. Diabetes Therapy: Research, Treatment and Education of Diabetes and Related Disorders, 11(3), 607–619.

Kalra, S., Jena, B. N., & Yeravdekar, R. (2018). Emotional and psychological needs of people with diabetes. Indian Journal of Endocrinology and Metabolism, 22(5), 696–704.

LeRoith, D., Biessels, G. J., Braithwaite, S. S., Casanueva, F. F., Draznin, B., Halter, J. B., Hirsch, I. B., McDonnell, M. E., Molitch, M. E., Murad, M. H., & Sinclair, A. J. (2019). Treatment of diabetes in older adults: An Endocrine Society* clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(5), 1520-1574.

Luo, J., & White-Means, S. (2018). Feasibility and acceptability of using smartphone apps in diabetes self-management in an underserved population: Qualitative study. Iproceedings, 4(2), e11792.

Quinn, C. C., Khokhar, B., Weed, K., Barr, E., & Gruber-Baldini, A. L. (2016). Older adult self-efficacy study of mobile phone diabetes management. Diabetes Technology & Therapeutics, 17(7), 455–461.

Rebolledo, J. A., & Arellano, R. (2016). Cultural differences and considerations when initiating insulin: TABLE 1. Diabetes Spectrum, 29(3), 185-190.

Zeh, P., Sandhu, H. K., Cannaby, A. M., Warwick, J., & Sturt, J. A. (2016). Exploring culturally competent primary care diabetes services: A single-city survey. Diabetic Medicine: A Journal of the British Diabetic Association, 33(6), 786–793.

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NursingBird. (2022, March 25). CLC - Evidence-Based Practice Project: Intervention on Diabetes. Retrieved from https://nursingbird.com/clc-evidence-based-practice-project-intervention-on-diabetes/

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NursingBird. (2022, March 25). CLC - Evidence-Based Practice Project: Intervention on Diabetes. https://nursingbird.com/clc-evidence-based-practice-project-intervention-on-diabetes/

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"CLC - Evidence-Based Practice Project: Intervention on Diabetes." NursingBird, 25 Mar. 2022, nursingbird.com/clc-evidence-based-practice-project-intervention-on-diabetes/.

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NursingBird. (2022) 'CLC - Evidence-Based Practice Project: Intervention on Diabetes'. 25 March.

References

NursingBird. 2022. "CLC - Evidence-Based Practice Project: Intervention on Diabetes." March 25, 2022. https://nursingbird.com/clc-evidence-based-practice-project-intervention-on-diabetes/.

1. NursingBird. "CLC - Evidence-Based Practice Project: Intervention on Diabetes." March 25, 2022. https://nursingbird.com/clc-evidence-based-practice-project-intervention-on-diabetes/.


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NursingBird. "CLC - Evidence-Based Practice Project: Intervention on Diabetes." March 25, 2022. https://nursingbird.com/clc-evidence-based-practice-project-intervention-on-diabetes/.