One of the population health problems relevant to contemporary nursing practice is Diabetes mellitus. Also known as “diabetes”, it is a group of metabolic diseases characterized by high blood sugar (glucose) levels that result from defects in insulin secretion, or its action, or both (Benoit et al., 2020). Diabetes can lead to serious health complications, including heart disease, blindness, kidney disease, and amputations. There are two main types of this condition: type 1 diabetes is a form caused by an autoimmune reaction in which the body’s immune system attacks and destroys the cells in the pancreas producing insulin (Benoit et al., 2020). Type 2 diabetes, in turn, is caused by a combination of insulin resistance, which refers to the body’s cells not responding properly to insulin, and insufficient insulin production. The population health problem defined in this research is the occurrence of hyperglycemic episodes in patients with type 2 diabetes.
Patient and Relevance
An individual interviewed during these practicum hours was an elderly family member with type 2 diabetes. This family member is a 75-year-old woman who was diagnosed 8 years ago. Her body weight at the time of the interview was 68.0 kg, and she has suffered from several hyperglycemic episodes over the past 5 years. This case and the problem in general are extremely important for my practice as a baccalaureate-prepared nurse because diabetes is a significant health issue that affects a large portion of the population. Baccalaureate-prepared nurses have to be trained and well-suited to help patients with diabetes manage their condition and prevent complications by providing ongoing support and education. To present the ideas about the problem to the patient and convince her of its significance, I will try to share with her the evidence related to the problem and measures to manage it.
However, there are several potential barriers that may arise when presenting this problem to the patient, including lack of understanding, emotional barriers, cognitive barriers, and physical barriers. To overcome these, change management strategies such as effective communication, involvement and empowerment, flexibility, support, and collaboration can be employed. During these practicum hours, I hope to learn more about the causes and consequences of hyperglycemic episodes in patients with type 2 diabetes, as well as about the defined patient’s experiences and perspectives.
Evidence on Nursing Actions
Peer-reviewed literature and sources studied during the preparation for the project showed that there are several nursing actions that may be appropriate for a patient with type 2 diabetes who has suffered from hyperglycemic episodes. These actions may include regularly monitoring the patient’s blood sugar levels, administering medications as needed, providing education and support to the patient, coordinating care with other healthcare professionals, and providing emotional support (Andriyanto et al., 2019). It is important for the nurse to be familiar with the patient’s specific treatment plan and goals, as well as any underlying conditions or factors that may be contributing to their hyperglycemic episodes. For example, depending on the causes of the episode, nurses can teach patients different self-management skills, such as how to adjust their insulin doses or make lifestyle changes to help prevent future episodes. Overall, the evidence from the literature is consistent with what I see in my nursing practice, as these measures have been taken by me and my colleagues when treating patients with diabetes.
However, if the data were unreliable, I would be able to identify that using a number of indicators. First, I would pay attention to the transparency of the source; if the research study does not clearly describe the methods and procedures used, it is a reason to question the reliability of the data. Second, I would consider the sample size: studies with a small sample size may not be representative of the larger population. I would also study the source for possible inconsistencies: if the data collected in the study is inconsistent or contradicts other research findings, it may be unreliable. Other important indicators would be poor study design and the lack of replication; if the study design is flawed, it can compromise the reliability of the data. In turn, if the results of the study cannot be replicated by other researchers, it may also be an indication that the data is unreliable.
Existing Barriers
The literature review has also revealed a number of barriers to the implementation of evidence-based practice in addressing the problem of hyperglycemic episodes associated with diabetes. These barriers include limited access to evidence, time constraints, the lack of training, resistance to change, limited resources, and organizational factors (Benoit et al., 2020). Thus, Benoit et al. (2020) state that to overcome these constraints, it is necessary to prioritize evidence-based practice and create a supportive environment for its implementation. This may involve providing training and resources for nurses, encouraging a culture of continuous learning and improvement, and addressing any organizational factors that may be hindering the implementation of evidence-based practices.
The Role of Nurses
Current literature also emphasizes the vital role nurses play in policy making to improve outcomes, prevent illness, and reduce hospital readmissions. According to Nilsen et al. (2020), nurses can contribute their expertise to inform decision-making at the local, state, and national levels, as well as advocate for policies that align with nursing values and principles. Nurses can also contribute to policy making by conducting research and gathering data to support the development of evidence-based policies. In addition, nurses can influence policy through their everyday practice by providing high-quality care and advocating for the needs of their patients. The role of nurses in policy making is crucial in promoting patient-centered care, improving outcomes, and reducing healthcare costs.
Nursing Theories and Frameworks
The large body of literature on the topic has also provided a number of theories and frameworks that guided my actions during the practicum. The nursing process and Health Belief Model are two commonly used theories (Younas & Quennell, 2019). The nursing process involves assessing, diagnosing, planning, implementing, and evaluating care. The Health Belief Model proposes that individuals’ health behaviors are influenced by their perceptions of a health problem, susceptibility, benefits, and barriers to taking action (Brandão et al., 2019). Other useful theories and frameworks include the Roy Adaptation Model, the Self-Care Deficit Theory, and the Neuman Systems Model.
Nursing Standards and Policies
Studies have also shown that nursing standards and policies can be effective in improving patient, family, or population outcomes for the problem of hyperglycemic episodes associated with diabetes. According to Broadley et al. (2019), these standards and policies provide guidelines for the management of hyperglycemic episodes and help to ensure that patients receive high-quality, consistent care. By following nursing standards and policies, nurses can provide appropriate, evidence-based care that is tailored to the individual needs of patients with diabetes. This can help to reduce the frequency and severity of hyperglycemic episodes and prevent complications (Broadley et al., 2019). Overall, nursing standards and policies can be an important tool in improving patient care and outcomes for individuals with diabetes.
It can be argued that state board nursing practice standards and organizational or governmental policies could also help to address the defined problem. These standards could be used to ensure that nurses are providing high-quality, evidence-based care that is consistent with the latest research and guidelines. The latter can include specifying guidelines for the monitoring and management of hyperglycemic episodes, as well as outlining the roles and responsibilities of nurses in addressing this problem. For example, state board nursing practice standards might specify that nurses must regularly assess and monitor the blood sugar levels of patients with type 2 diabetes, and take appropriate action to prevent or manage hyperglycemic episodes. Organizational policies might outline protocols for the administration of insulin or other medications to manage blood sugar levels, or specify the types of self-management strategies that nurses should teach patients to prevent hyperglycemic episodes.
Many studies have tested the effectiveness of these standards, demonstrating that they are helpful in addressing the problem of hyperglycemic episodes in patients with type 2 diabetes. In addition to specifying guidelines for care, state board nursing practice standards can also help to create a culture of quality and safety within the organization, which can further support improved patient outcomes (Powers et al., 2021). By setting clear expectations for nursing practice, organizations can help to foster a culture of continuous learning and improvement, which can ultimately lead to better patient care and outcomes.
Local, state, and federal policies or legislation can also have a range of effects on the nursing scope of practice within the context of hyperglycemic episodes in patients with type 2 diabetes. These policies and legislation can set guidelines and expectations for nursing practice and determine what actions nurses are permitted to take in the management of hyperglycemic episodes. They can also outline the roles and responsibilities of nurses and determine the extent to which they are able to make independent decisions about patient care. In addition to specifying guidelines and expectations for nursing practice these policies or legislation can also influence the resources and support available to nurses, which can affect the nursing scope of practice significantly.
Leadership Strategies
A number of leadership strategies can be proposed to improve outcomes, patient-centered care, and the patient experience related to managing hyperglycemic episodes in patients with type 2 diabetes. These include providing education and training, promoting evidence-based practice, supporting patient-centered care, fostering teamwork and collaboration, and evaluating and continuously improving care. All these strategies can be implemented through education and training opportunities, resources and support for staying up-to-date on research and guidelines, patient involvement in decision-making, and quality improvement initiatives.
Research shows that these leadership strategies are effective because they address a range of factors that can influence the quality of care and patient outcomes related to the management of the defined problem. Providing education and training helps to ensure that nurses have the knowledge and skills needed to provide high-quality care, and promoting evidence-based practice can help to reduce the risk of unnecessary or inappropriate interventions. Supporting patient-centered care can improve the patient experience by involving patients in decision-making and respecting their preferences and needs. Fostering teamwork and collaboration can promote communication and coordination among healthcare professionals, leading to seamless, coordinated care that meets patients’ needs. Evaluating and continuously improving care can identify areas for improvement and implement changes that can lead to better patient outcomes. Together, these strategies can support the delivery of high-quality care that is tailored to the needs of individual patients and leads to improved patient outcomes and experiences.
Overall, leadership is anticipated to play a critical role in addressing the problem of hyperglycemic episodes in patients with type 2 diabetes. Leaders can set the vision and direction for the organization and influence the policies, practices, and culture that shape care delivery. By providing direction and support for the management of hyperglycemic episodes, leaders can help to ensure that patients with type 2 diabetes receive high-quality, evidence-based care that is tailored to their needs and that aims to prevent or manage hyperglycemic episodes.
Collaboration and Communication Strategies
In addition to the leadership strategies discussed above, it is anticipated that a number of collaboration and communication strategies will be required to address the problem of hyperglycemic episodes in patients with type 2 diabetes. These strategies include promoting inter-professional collaboration and communication, involving patients in the decision-making process and encouraging patient self-management, sharing information and data electronically, providing clear, concise communication, and establishing protocols and guidelines. Using these strategies can help to ensure that patients receive coordinated, seamless care that meets their needs and aims to prevent or manage hyperglycemic episodes. Effective collaboration and communication are essential for addressing the problem of hyperglycemic episodes and can help to improve patient outcomes and experiences.
Change Management Strategies
Finally, change management strategies that will be needed to address the given problem include identifying the need for change, engaging stakeholders, developing a plan, implementing the change, and evaluating the change. These strategies can help to ensure that changes are aligned with the needs and priorities of stakeholders, are implemented smoothly and efficiently, and are having the desired impact on patient outcomes and experiences. By using these strategies, organizations can effectively address the problem of hyperglycemic episodes in patients with type 2 diabetes and implement changes that lead to improved patient outcomes and experiences.
References
Andriyanto, A., Rekawati, E., & Rahmadiyah, D. C. (2019). Increasing knowledge, attitudes, skills, and glucose control in type-2 diabetic patients through EMAS interventions. Nurse Media Journal of Nursing, 9(2), 141-150. Web.
Benoit, S. R., Hora, I., Pasquel, F. J., Gregg, E. W., Albright, A. L., & Imperatore, G. (2020). Trends in emergency department visits and inpatient admissions for Hyperglycemic crises in adults with diabetes in the U.S., 2006–2015. Diabetes Care, 43(5), 1057-1064. Web.
Brandão, M. A., Barros, A. L., Caniçali Primo, C., Bispo, G. S., & Lopes, R. O. (2019). Nursing theories in the conceptual expansion of good practices in nursing. Revista Brasileira de Enfermagem, 72(2), 577-581. Web.
Broadley, L., Clark, K., & Ritchie, G. (2019). Prevention and management of hyperglycaemic crisis. Nursing Standard, 34(7), 75-82. Web.
Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: An interview study with physicians, registered nurses and assistant nurses. BMC Health Services Research, 20(1). Web.
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L. M., & Uelmen, S. (2021). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the association of diabetes care & Education specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American pharmacists association. The Science of Diabetes Self-Management and Care, 47(1), 54-73. Web.
Younas, A., & Quennell, S. (2019). Usefulness of nursing theory‐guided practice: An integrative review. Scandinavian Journal of Caring Sciences, 33(3), 540-555. Web.