CAPSTONE: PART III
1. Implementation/Conclusion
– Implement the change you are proposing- This should be a continuation of Part I and Part II
2. Describe the practice change; is it in the community, organizational, clinic setting and so forth
3. Discuss how you would implement and assess the change; this should include time frame, setting, participants, barriers, external and internal factors.
4. How would you evaluate the change process?
-The change must be measurable
-How would you measure or evaluate? Is there a tool to measure?
5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project.
6. Discuss who will be invited to the proposal: who are the stakeholders?
-How will you present the information to your stakeholders?
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Inadequate Management of Type 2 Diabetes among Adult Patients.
Student’s Name
Institutional Affiliation
Course
Instructor
Date.
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Inadequate Management of Type 2 Diabetes among Adult Patients.
Type 2 Diabetes is one serious problem having a considerable effect on health
expenditures and human life. In most parts of the world, urbanization and increased economic
development have caused a rise in the diabetes burden. Diabetes most affects the functional
capacities of individuals as wells as their quality of life, leading to premature mortality and
significant morbidity. This paper, therefore, proposes implementing a structured diabetes selfmanagement education program within the hospital’s outpatient clinic or community health
center and discusses the Social Cognitive Theory (SCT as the nursing theoretical framework.
Significance of the Problem.
The problem is significant as it impacts patients, the community, the cost of care, and the
quality of life. In the case of the patients, inadequate management of type 2 diabetes can lead to
poor glycemic control, which increases the risk of complications such as cardiovascular disease,
neuropathy, and retinopathy. The community is also impacted by increased healthcare utilization,
including frequent hospital readmissions, which can strain healthcare resources and impact the
community’s overall health outcomes and costs (Khan et al., 2020). In regard to the impact on the
cost of care, poorly managed type 2 diabetes can result in increased healthcare costs due to
frequent hospital admissions, emergency department visits, and complications. Lastly, the quality
of life is also impacted, affecting patients’ physical, emotional, and social well-being, leading to
reduced quality of life.
Problem Description.
Type 2 Diabetes is a condition that occurs due to complications in the way one’s body
regulates and uses sugar or glucose as fuel (Khan e al., 2020). When the condition prolongs,
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there will be too much circulation of sugar in the blood. Consequently, there will be high sugar
levels in the blood, which would lead to various disorders in the nervous, immune, and
circulatory systems.
PCOT Statement.
In a community hospital setting of patients (P) with type 2 diabetes, does implementing a
comprehensive diabetes self-management education program (I) compared to standard care (C)
lead to improved glycemic control, reduced hospital readmissions, enhanced quality of life,
reduced healthcare costs (O) during Adulthood(T)?
Data and Statistics.
According to Khan et al. (2020), Type 2 Diabetes is a severe complication that leads to
about 1 million deaths each year globally. In 2017, it was estimated that about 462 million
people worldwide suffered from type 2 diabetes. 4.4% of the population consisted of those aged
15 to 49 years, 15% of those aged 50 to 69, percent while 22% were aged 70 and above (Khan et
al., 2020). The prevalence rate was estimated to be 6059 victims per 100,000 people.
Purpose Statement and Proposed Program.
This project aims to design an evidence intervention strategy for the patients who attend
the community hospital setting to reduce the severity and incidence of type 2 diabetes during
adulthood. The focus of the program will be to improve glycemic control, reduce hospital
readmissions, enhance quality of life, and reduce healthcare costs.
Proposed Outcome.
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The intended outcome will be to reduce the severity and incidence of type 2 diabetes
during adulthood. The outcome will be measured by comparing the comprehensive diabetes selfmanagement education program to standard care through the objective clinical criteria.
PICOT.
The following are the elements to be discussed:
Population (P). The key population for the study will consist of elderly people attending
community hospitals.
Intervention (I). The intervention that the study proposes is implementing a structured
diabetes self-management education program within the hospital’s outpatient clinic or
community health center to provide education, support, and resources for patients with type 2
diabetes.
Comparison Intervention(C). The group for the comparison will be enrolled under
standard care. The standard care would include routine care such as dietary advice and regular
checkups.
Outcome (O). The main outcome of the study will be to reduce the severity and
incidence of type 2 diabetes during adulthood. The outcome will be measured through a
comparison of the comprehensive diabetes self-management education program to standard care
in both comparison and intervention groups.
Timing (T). The intended time for the study will be during adulthood.
The Vulnerable Population.
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The most vulnerable population is adults aged 35 and above (National Institute of
Diabetes and Digestive and Kidney Diseases, 2022). Teens and children may also be affected by
type 2 diabetes. However, the more the person gets older, the more the risk increases. The risk
factors include obesity or overweight, history of diabetes in the family, American Indian/African
American, Asian American, Pacific Islander or Hispanic/Latino, prediabetes, gestational
diabetes, or physically inactive.
Proposal
The intervention would involve implementing a structured diabetes self-management
education program within the hospital’s outpatient clinic or community health center to provide
education, support, and resources for patients with type 2 diabetes. The proposal will involve
education on checking sugar levels regularly, dieting, being active, handling stress, and taking
the prescribed medicines. The focus will also be to provide education on the signs and symptoms
of type 2 diabetes and the importance of early intervention. There will be emotional support
through individual counseling and group sessions. To ensure that the elderly get the necessary
resources for the intervention, exercise guides, health recipes, and other educational materials
about type diabetes will be provided. A nurse will be identified to help the elderly during
counseling sessions and group sessions about physical activities, eating habits, as well as other
topics related to type 2 diabetes.
The proposed time frame will be 6 months. Out of the 6 months, the 1st month will be
used for program development, including recruiting participants and designing educational
materials. The rest of the months will be dedicated to implementing the program with individual
counseling, group sessions, and follow-up assessments. The SMEs programs will certainly
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reduce complications related to diabetes, improve the quality of life, and lower medical
expenses.
Theoretical Framework/Nursing Theory.
For the proposed research question on implementing a comprehensive diabetes selfmanagement education program in a community hospital setting, a nursing theoretical
framework that can be used is the Social Cognitive Theory (SCT). The Social Cognitive Theory,
developed by Albert Bandura, emphasizes the reciprocal relationship between personal factors,
behavior, and the environment. The social cognitive theory emphasizes the learning that occurs
within a social context. In this view, people are active agents who can both influence and are
influenced by their environment (Nickerson, 2023). It posits that individuals learn and change
their behaviors through observation, self-efficacy beliefs, and self-regulation.
As noted by Nickerson (2023), the theory suggests that behavior change occurs when
individuals have confidence in their ability to perform new behaviors, perceive positive
outcomes, and have supportive environments. In the context of the proposed research question,
the Social Cognitive Theory provides a framework to understand and guide the implementation
of the diabetes self-management education program. It recognizes that behavior change and selfmanagement skills are influenced by personal factors, such as self-efficacy and outcome
expectations, as well as environmental factors, such as social support and access to resources. By
utilizing the Social Cognitive Theory, the research can assess the impact of the comprehensive
education program on self-efficacy beliefs, knowledge acquisition, and behavior change among
patients with type 2 diabetes.
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References.
Khan, M. A., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Kaabi, J. A. (2020,
March 10). Epidemiology of Type 2 Diabetes – Global Burden of Disease and Forecasted
Trends. Retrieved from National Library of Medicine:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310804/
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2022, July). Risk
Factors for Type 2 Diabetes. https://www.niddk.nih.gov/healthinformation/diabetes/overview/risk-factors-type-2-diabetes
Nickerson, C. (2023, February 13). Albert Bandura’s Social Cognitive Theory: Definition &
Examples. Retrieved from SimplyPsychology.org:
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Literature Review
Lexania Matos
Carmen Lazo
MSN Capstone Project
July 23, 2023
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Literature Review
Review
Type 2 diabetes is a form of diabetes that has many issues concerning how it can affect
the individual with the disease for instance in aspects surrounding their day-to-day activities and
welfare. In such a situation, this form of diabetes requires a sensitive approach in the manner of
care that can be offered or that can be done by the individuals. This will be to ensure that there is
the creation of an environment whereby these people live in a way that does not compromise
their ability to enjoy different aspects of life. It is ideal to note that different interventions are
present to ensure that people who have diabetes can enjoy a sense of freedom when it comes to
the way that they can promote their care (Biamonet et al., 2021). The practice change in this case
is the move towards a form of care that focuses on implementing a comprehensive diabetes selfmanagement education program that can be used to ensure that people who have type 2 diabetes
can focus on healthy lifestyles that reduce hospital readmissions, enhance quality of life, and
reduce health care costs. These interventions are all grounded in the aspect of a means of care
that is centered on the ability of an individual with type 2 diabetes to implement a comprehensive
practice that is based on self-management. According to Biamonet et al. (2021), selfmanagement, in this case, refers to the ability of an individual with type 2 diabetes to foster the
creation of an environment where they can focus on different approaches that can help ensure
that, as diabetics, they leave life in a manner that promotes a sense of being healthy (Biamonet et
al., 2021). These aspects can effectively promote the monitoring of glycemic levels. Through
this, individuals can ensure that they have the right knowledge and skills to help manage their
glucose levels in a considerate and more effective manner.
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According to Hildebrand et al. (2020), blood glucose monitoring is one of the most
important ideas that can be taught among patients who have type 2 diabetes in that it provides an
environment where it can be possible for the patients to understand what monitoring implies and
why such can be helpful in the making of an environment where they get to live life healthily
(Hildebrand et al., 2020). In agreement, Ji et al. (2019) and Liu et al. (2019) find that it is
important for the individual to be in a position to understand the different ways that monitoring
can be done as well as the different ideas that are considered the monitoring element, such as the
technologies used in the monitoring process (Liu et al., 2019), (Ji et al., 2019).
Research promotes the idea that patients must understand the relationship between
different monitored levels and their well-being, especially considering that these levels create a
sense of indication of whether the person is living a healthy life. Haider et al. (2019) provide that
in understanding such prospects, it can be possible for these individuals to create a situation
whereby they can adapt different ideas that are taught to them in a way that facilitates continuous
improvement concerning the aspect of taking control of the diagnosis that they have been given
(Haider et al., 2019), (Hildebrand et al., 2020). This helps reduce hospitality admissions and
enhances quality of life by ensuring that individuals can stay in check in relation to their
lifestyle, especially because poor management is the leading cause of complications among
people with Type 2 diabetes. It can also be possible for such an individual to pay a visit to the
hospital whenever they record an indication of a need for such.
As part of the educational approach, nutritional education is also an important element
that can help foster an environment whereby hospital costs are reduced, given that patients
become better due to lifestyle changes. Mamo et al. (2019) argue that patients must understand
the importance of aspects such as carbohydrate counting and glycemic index (Mamo et al.,
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2019). Through being insightful about such aspects, it can be possible for patients to come up
with different ways of practicing food control in a way that promotes their health. The aspect of
nutritional education will go well with the idea of practicing physical activity education in the
sense that through such aspects, there is the construction of an environment whereby the patients
can be taught the benefits of combining good exercises and good nutrition concerning ensuring
that their body is protected from issues such as cardiovascular diseases that are prone to affect
people with type 2 diabetes (Fekadu et al., 2019). Chwala et al. (2019) assert that with such an
education, an individual with type 2 diabetes will be in a position to not only live a healthy
lifestyle concerning the fact that they have a disease but they will also be in opposition to
fostering a healthier experience that puts them at a great advantage concerning other individuals
who may not have type 2 diabetes but live life in a way that is not healthy (Chwala et al., 2019).
Hypoglycemia management is also a key aspect taught in the sense that this aspect relates
to the idea of controlling high blood sugar levels to ensure the patient survives through any issue.
According to Bukhsh et al. (2019), by having such an understanding, the patients can be in a
position to work towards living a lifestyle that considers that at any one point, their blood sugars
may go up, which may require them to practice some aspects before their visitation to the
hospital, such as staying hydrated (Bukhsh et al., 2019). In some cases, the patients may also
suffer from hypoglycemia. This implies that hypoglycemia management is also a key aspect that
is considered. Bukhsh et al. (2019) provide that in such training, patients can be taught how to
focus on steps to follow whenever they have issues with low blood sugars, such as having a
snack that has a high glucose content, which is often needed in such cases.
Objectives
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The main objective of the intervention will be to create an environment where people
living with type 2 diabetes can enact procedures grounded in self-management in a way that
ensures that the rate of readmissions due to complications related to type 2 diabetes can be
reduced among adults.
It is also an objective to ensure that there is the creation of an environment whereby it can
be possible to ensure a continuous sense of support and follow-up to ensure that patience works
with the ideas presented to them in the education process.
Another objective for the practice change is creating an environment whereby it can be
possible to promote an education program that considers or addresses the needs of different
individuals in society who differ from others concerning ideas such as cultural context as well as
gender and sexuality. This will be an aspect that will ensure that there is inclusivity in the
education provided and also ensure that the ideas presented in the whole experience can be
enacted or utilized by individuals across different characteristics on the social spectrum.
It will also be important to ensure that there is the creation of an environment whereby it
can be possible to reduce hospital readmissions, and this can be done by promoting a sense of
lifestyle that considers the needs of people living with type 2 diabetes. Such reductions will be
grounded on the ability of the practice change to impact the skills and knowledge of civilians to
ensure that they are better able to handle the aspect of being diabetic (Haider et al., 2019). This
will ensure that there is a hands-on approach to the entire process since care will also be
sustained by the individual who is sick, thereby significantly improving efficiency.
Existence of the Issue
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The problem exists in the sense that in the healthcare setting, there are often different
aspects that are taught to healthcare personnel that can foster the creation of an environment
whereby type 2 diabetes is taken care of. However, with the patients’ ability to focus their efforts
towards realizing better health, such efforts succeed (Liu et al., 2019). This leads to a situation
whereby individuals with type 2 diabetes do not do enough to ensure optimal glycemic control.
With suboptimal glycemic control, there is the creation of an environment where the risk
increases hospital readmissions given that people with type 2 diabetes over-rely on healthcare
personnel to foster the creation of better outcomes for them in terms of acquiring better health.
From such a perspective, Fekadu et al. (2019) promote that the problem of poor glycemic control
exists due to the inadequate understanding of aspects related to type 2 diabetes among people
living with the illness. The proposition for change is, therefore, the creation of an environment
whereby people living with type 2 diabetes can employ self-management ideas that are presented
to them based on an education program that facilitates their interaction between such individuals
and healthcare personnel in a way that allows them to understand different concepts that are key
to the control of glycemic levels in their body.
Relevance or Applicability
One of the aspects that can be tied to the practice change in the sense of the pro of the
idea is the fact that it offers a platform that enhances quality of life among patients through the
creation of an environment whereby they can focus on different ideas that ensure that their
lifestyles can establish a good sense of glycemic control (Hildebrand et al., 2020). Another
important consideration is the idea that, through such efforts, it can be possible to alleviate the
efforts needed to help patients who have type 2 diabetes, and this allows healthcare personnel to
focus on other issues that are also equally important.
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Cons
It is important to note that the practice change may also have some implications that may
be viewed as negative because it requires a sense of resource utilization. The resources being
utilized include personnel for providing education and funding to promote the allocation of the
research towards such. This can create some constraints, especially regarding the fact that
healthcare facilities are often underfunded, especially considering that there are many needs to
cater for. According to Al-Sahouri et al. (2019), another possible issue may be that some
individuals may not be receptive to the idea of being educated on self-care concerning the aspect
that they may want direct help from healthcare personnel, especially considering that they may
have some reservations regarding their ability to perform as expected. Such an issue may limit
the efficiency of the practice change (Al-Sahouri et al., 2019).
Strengths and Weaknesses of the Articles
The main strength of the articles is that they all refer to a topic that is directly related to
the PICO question implying that they effectively provide key insight in the whole review. It is
ideal to note that they all focus on the aspect of focusing on self-management of glycemic levels
as a way of promoting better health outcomes for people living with type 2 diabetes. However,
one of the challenges presented is that the resources need to consider patient engagement in their
approach, which makes them questionable in relation to the needs catered for. The article by
Bukhsh et al. (2019) also needs to improve because it does not establish causality, although this
is due to the use of cross-sectional design, which is often the case in such designs.
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References
Al-Sahouri, A., Merrell, J., & Snelgrove, S. (2019). Barriers to good glycemic control levels and
adherence to diabetes management plan in adults with Type-2 diabetes in Jordan: a
literature review. Patient preference and adherence, 675-693.
Biamonte, E., Pegoraro, F., Carrone, F., Facchi, I., Favacchio, G., Lania, A. G., … & Mirani, M.
(2021). Weight change and glycemic control in type 2 diabetes patients during COVID19 pandemic: the lockdown effect. Endocrine, 72(3), 604-610.
Bukhsh, A., Khan, T. M., Sarfraz Nawaz, M., Sajjad Ahmed, H., Chan, K. G., & Goh, B. H.
(2019). Association of diabetes knowledge with glycemic control and self-care practices
among Pakistani people with type 2 diabetes mellitus. Diabetes, metabolic syndrome and
obesity: targets and therapy, 1409-1417.
Chawla, S. P. S., Kaur, S., Bharti, A., Garg, R., Kaur, M., Soin, D., … & Pal, R. (2019). Impact
of health education on knowledge, attitude, practices and glycemic control in type 2
diabetes mellitus. Journal of family medicine and primary care, 8(1), 261.
Fekadu, G., Bula, K., Bayisa, G., Turi, E., Tolossa, T., & Kasaye, H. K. (2019). Challenges and
factors associated with poor glycemic control among type 2 diabetes mellitus patients at
Nekemte Referral Hospital, Western Ethiopia. Journal of multidisciplinary healthcare,
963-974.
Haider, R., Sudini, L., Chow, C. K., & Cheung, N. W. (2019). Mobile phone text messaging in
improving glycaemic control for patients with type 2 diabetes mellitus: a systematic
review and meta-analysis. Diabetes research and clinical practice, 150, 27-37.
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Hildebrand, J. A., Billimek, J., Lee, J. A., Sorkin, D. H., Olshansky, E. F., Clancy, S. L., &
Evangelista, L. S. (2020). Effect of diabetes self-management education on glycemic
control in Latino adults with type 2 diabetes: a systematic review and meta-analysis.
Patient Education and Counseling, 103(2), 266-275.
Ji, H., Chen, R., Huang, Y., Li, W., Shi, C., & Zhou, J. (2019). Effect of simulation education
and case management on glycemic control in type 2 diabetes. Diabetes/Metabolism
Research and Reviews, 35(3), e3112.
Liu, J. X., Zhu, L., Li, P. J., Li, N., & Xu, Y. B. (2019). Effectiveness of high-intensity interval
training on glycemic control and cardiorespiratory fitness in patients with type 2 diabetes:
a systematic review and meta-analysis. Aging clinical and experimental research, 31,
575-593.
Mamo, Y., Bekele, F., Nigussie, T., & Zewudie, A. (2019). Determinants of poor glycemic
control among adult patients with type 2 diabetes mellitus in Jimma University Medical
Center, Jimma zone, south-west Ethiopia: a case-control study. BMC endocrine
disorders, 19, 1-11.
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