Introduction
Professional nurses collect data, prepare reports and conduct monitoring. This information forms the basis of benchmark data that compares the quality of patient safety services. This paper will explore data on the issue of diabetes self-management, which I discussed earlier in other assessments. The 61-year-old female patient was diagnosed with type 2 diabetes five years ago at age 56. She tried to cope with the disease with a home approach, but the treatment was not enough effective. She currently has suffered from several hyperglycemic episodes over the past year. At the time of the interview, her weight was 77.7 kg. The patient is a friend of the family that cares for her.
Type 2 diabetes mellitus (T2DM) is one of the most common metabolic disorders worldwide. According to Galicia-Garcia et al. (2020), patients with T2DM have a 15% increased risk of all-cause mortality compared with people without diabetes. Although T2DM has a strong genetic basis, many cases of T2DM can be prevented by improving major modifiable risk factors such as obesity, physical inactivity, and unhealthy diet. This paper aims to find diabetes self-management solutions. This issue also applies to my clinical practice because it emphasizes using evidence-based approaches to treat T2DM effectively.
Assessment of the Patient, Family, or Population Problem
Diabetes is one of the ten leading causes of death in the world. It caused 1.6 million deaths in 2015, indicating a 60% increase over 15 years from less than 1 million in 2000 (Adu et al., 2019). International audits have shown that treatment adherence in patients with type 1 and type 2 diabetes is less than optimal. Consequently, most of these patients are at risk of severe life-threatening health complications and place a heavy economic burden on affected individuals and the health care system.
In contrast, uninterrupted involvement in self-management of type 2 diabetes is correlated with health outcomes in terms of good blood glucose control, fewer complications, improved quality of life and, decreased diabetes-related risk, reduced risk of death (Adu et al., 2019). The term “self-management” refers to the day-to-day activities a person must take to control or reduce the impact of illness on their health and well-being in order to prevent further illness. Diabetes self-management activities include engaging in recommended behavioral activities such as healthy eating, medication adherence, activity, monitoring, risk reduction, problem-solving, and healthy coping, which are essential to successfully managing the disease.
Effective communication between the health care provider and the patient is one of the factors that favorably influence a patient’s decision to self-manage. Such collaboration is characterized by trust, respect, and shared decision-making in planning health goals (Adu et al., 2019). According to Tuohy (2019), intelligent communication in nursing is essential to ensure optimal patient care. The manager is empowered to ensure the proper exchange of information between the stakeholders involved in managing the patient’s condition. Leadership and change management significantly affected the development of the proposed medical interventions for my patient.
In the treatment of diabetes, the level of self-efficacy of patients depends on the level of their self-management skills. Consequently, patients with adequate skills and performance are more likely to adhere to the prescribed behavioral regimen needed to achieve optimal health (Powers et. Al, 2020). Acquiring skills in diabetes self-management and its effectiveness is a continuous learning process. One method of education could be patient support using medical technology interventions such as mobile phone applications to monitor treatment and diet and educate patients with diabetes.
Thus, during practical hours, I determined that the problem of Diabetes Self-management has a positive effect on Patient Safety, as the risks of developing complications and adverse outcomes are reduced. The Quality of Care improves as a trusting and reliable relationship is established between the medical provider and the doctor. In addition, the cost of medical care is reduced, as regular self-management prevents crises, complications, and the number of hospitalizations.
The features listed above defined my communication with the patient and facilitated consultation meetings with a family that intended to provide patient-centered care. During these meetings, I learned that the patient was not on a diet, skipped medication, and sometimes added sugar to her meals. I required the patient to follow a diet, exercise regularly, and reduce her sugar intake to controlling weight. I recommended constant monitoring of blood sugar and medication. In addition, I advised installing a smartphone app to monitor adherence to the recommendations and keep a diary of food and changes in blood sugar readings. My leadership strategy allowed the patient to accept the set of standard medical interventions that I suggested to her.
For studying nursing practice standards and strategies, I reviewed several evidence-based practice documents:
- The report of the American Diabetes Association, the Association of Diabetes Care, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Association of Nurse Practitioners, and the American Pharmacists (Powers et al.,2020).
- The cross-sectional study about the role of transformational leadership, work environment and patient safety culture (Ree, 2020).
- The research ethics and scientific integrity (West, 2020).
From the review I learned the standards of communication and collaboration with patients and their families for successful treatment. These standards include providing honest and complete information about the disease in a way that the patient can understand. Based on the review, the patient should have a choice that can be made on the basis of complete information. In addition, nursing practice standards include technology-based approaches to rapidly operate communication models in which the nurse, clinician, pharmacologist, and patient play their roles.
The knowledge gained helped me to offer patient and her friends a variety of approaches and settings for diabetes self-management education and support, allowing them to choose the method that best suits their needs. Traditionally, diabetes education services have taken place in healthcare settings during hospitalization, registration, treatment failure, or changes in quality of life (Powers et al., 2020). Technical services, including web-based programs, telemedicine, and smartphone applications, contribute to increased access to medical care, continuous education, and support (Powers et al., 2020). Support groups have proved to be another effective method, where patients with diabetes or their relatives can receive both social and psychological support.
An important standard of nursing practice was the collaboration between the patient and the practitioner. Ree (2020) argued that patient-centered care in clinical practice improves patient outcomes at the expense of therapy effectiveness. According to this, my task has been to ensure that each stakeholder is held accountable for the role they should play in terms of intervention. For instance, my patient had to follow an established eating plan, engage in physical activity, avoid sugar, and take medication. In addition, I urged my patient to participate in the Diabetes self-management education and support (DSMES) program.
During the sessions, I encountered barriers that hindered effective diabetes self-management. The first barrier was stress due to lifestyle changes; the patient’s depressed state did not allow her to act, aiming for success. The second barrier was the financial costs of treatment. The patient believed that buying drugs and food for her diet would be too expensive in her current financial situation. However, the arguments I provided based on calculations and data have shown that the costs of treatment are much lower than the costs of the ambulance services she paid for after hyperglycemic episodes.
I sought to build trust and confidentiality between patient and myself. West (2020) has shown that establishing a solid relationship of trust between practitioner and patient improves outcomes. Patients must be bold in disclosing confidential information to nurses to provide relevant information about the course of the disease. A trusting relationship between the patient and me ultimately led to the acceptance of the proposed interventions. Patient and her friends agreed with me about the presence of the problem and its significance and relevance.
After the sessions, I changed my definition of the problem, emphasizing working more with family members. The role of the patient’s environment is often underestimated. However, my practice has shown that the positive attitude from family and friends helps set the patients up for success and encourages them to monitor their indicators and diet carefully for avoiding complications and crises. I could have had more control over the organization of a suitable home environment if the patient had relatives living with her. The family of her friends wanted to help with the treatment, but could not be with the patient every day.
Effects of Policies on Nursing Scope
Nursing standards aim to protect the patient from malicious and harmful activities. The government initiates health policies such as the Affordable Care Act, Medicaid, and Medicare to ensure that doctor meets the needs of the patient (Carey et al., 2020). One of the concepts I implemented to provide adequate medical care for my patient was DSMES.
Local, state, and federal legislation provides care quality and patient safety of DSMES programs. Such legislation include the National Standards for Diabetes Self-Management Education and Support, a Summary list of standards and ADCES’s interpretation of the standards, and ADA Education Recognition Service Review Criteria and Indicators influence. These rules ensure constant patient care and safety across all medical organizations.
DSMES demonstrates effectiveness in terms of patient care and cost-effectiveness. People with diabetes who completed more than 10 hours of DSMES over 6–12 months significantly reduce mortality (Powers et al., 2020). Research shows that those involved in diabetes education are more likely to use best practices and incur lower healthcare costs (Powers et al., 2020). DSMES is cost-effective by reducing emergency room visits, hospitalizations, and readmissions.
Another problem that affects nursing policy and strategy is the cost of diabetes care. Healthcare costs for a person with diabetes are higher than for a person without diabetes. According to Powers et al. (2020), the cost of diabetes in the US in 2017 was $327 billion, including direct medical costs ($176 billion) and lost productivity ($69 billion). These data are confirmed by observation of my patient. She has suffered several hyperglycemic episodes over the past year, substantially increasing her and government healthcare costs.
To improve the quality of care, and reduce costs for the system and individuals, I suggest applying of technology tools more frequent. This approach simplifies diabetes self-management standards for patients and make learning more accessible and uninterrupted. In addition, this approach will reduce the costs of patients since they do not have to go to the hospital for every consultation.
The determination to prevent the development of complications is one of the main factors contributing to the self-management of diabetes. The study by Adu et al. (2019) confirms that medical technologies provide short-term and long-term health benefits for people with diabetes. The World Health Organization (WHO) has also confirmed that mobile technology can help deliver health outcomes that can transform healthcare systems worldwide.
Evidence-based therapies were developed to address the clinical problem of my type 2 diabetic patient. Relevant and available benchmark data sources were used such as administrative data, patient medical records, patient surveys, and standardized clinical data. I found and tried in practice strategies to ensure effective and collaborative communication between stakeholders. Government and the Nursing Council play their part in shaping nursing practice by setting specific requirements such as confidentiality and honesty.
Conclusion
Assessment show that diabetes self-management significantly effects the quality of care, patient safety, and costs for the state and patients. A patient with enough knowledge and skills to control this disease improves the quality of life and reduces the risk of complications and re-hospitalization. Ultimately, this decreases the cost of the state and patients on healthcare. A considerable role in the effective implementation of the Self-management program is played by the patient’s family and environment, which must have knowledge about diabetes and be able to create a safe environment for the patient. The standards and policies that the medical staff maintains significantly affect the quality of care.
References
Adu, M. D., Malabu, U. H., Malau-Aduli, A. E., & Malau-Aduli, B. S. (2019). Enablers and barriers to effective diabetes self-management: A multi-national investigation. PloS one, 14(6). Web.
Carey, C. M., Miller, S., & Wherry, L. R. (2020). The impact of insurance expansions on the already insured: the affordable care act and medicare. American Economic Journal: Applied Economics, 12(4), 288-318. Web.
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B.,& Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International journal of molecular sciences, 21(17), 6275. Web.
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., & Uelmen, S. (2020). 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. Diabetes Care, 43(7), 1636-1649. Web.
Ree, E. (2020). What is the role of transformational leadership, work environment and patient safety culture for person‐centred care? A cross‐sectional study in Norwegian nursing homes and home care services. Nursing Open, 7(6), 1988-1996. Web.
Tuohy, D. (2019). Effective intercultural communication in nursing. Nursing Standard, 34(2). Web.
West, E. (2020). Ethics and integrity in nursing research. Handbook of research ethics and scientific integrity, 1051-1069. Web.