NURS FPX 6011 Assessment 3 Implementing Evidence-Based Practice

NURS FPX 6011 Assessment 3

Implementing Evidence-Based Practice

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Student name

Capella University

FPX 6011

Professor name

Submission Date

Implementing Evidence-Based Practice

Evidence-based healthcare practice is a combination of most appropriate research evidence, clinical knowledge and patient values into a unified decision-making model. It involves a systematic approach to locate, evaluate, and use pertinent scientific literature to promote clinical outcomes (Engle et al., 2021). To conduct this assessment, there will be a creation of a Problem, Intervention, Comparison, Outcome, Time-bound (PICOT) question that will be answering the problem of diabetes. The assessment will also work out an action plan, establish the primary opportunities, and describe the primary interests. The outcome criteria will be recommended, and the suitability of the evidence selected to support the change of practice will be discussed.

PICOT Question for a Clinical Problem

How the introduction of extensive community-based management interventions of diabetes, including education and lifestyle changes (I) versus the standard care (C) is associated with adherence to lifestyle changes and self-management of blood glucose levels (O) after six months (T) in the population of adult American Indians and Alaska Native (AI/AN) with diabetes (P) type 2 diabetes?

• Population (P): AI/AN with type 2 diabetes
• Intervention (I): Community-based diabetes management interventions, including education and lifestyle changes
• Comparison (C): Standard care
• Outcome (O): Improve adherence to lifestyle changes and self-management of blood glucose levels
• Timeline (T): Six months

Background

One of the health problems of the AI/AN populations is type 2 diabetes as the population experiences a high rate of diabetes. The Centers for Disease Control and Prevention (CDC) reported that 13.6% of AI/AN adults were diagnosed with diabetes, and this is twice as many people as the non-Hispanic White group (6.9%) (Centers for Disease Control and Prevention, 2024). Some of the contributing factors are the presence of socioeconomic inequalities, lack of access to health, increased prevalence of obesity, and poor levels of physical exercise among populations. Rural, underserved locations that host AI/AN cannot receive several barriers to care services, including the distance or the resources required to understand the medical facility (Ottesen et al., 2022). The worst consequences of diabetes management are aggravated by poor management and high percentages of complications. Some of the interventions would be education and lifestyle change to enhance glycemic control (Shirvani et al., 2021). The intervention enhances treatment adherence and reduces the burdens of diabetes in the population.

Action Plan

Recommended Change

The provision of culturally complete community-based interventions is required in the first step of the evidence-based management of diabetes project among the AI/AN population. The measures will involve culturally applicable diabetes education, such as dietetic medicine, provisioning of traditional healthcare resources, mobile clinics and telemedicine, and lifestyle change assistance, which encompasses exercise programs and nutrition counseling (Powers et al., 2020). This cultural awareness and community involvement can be guaranteed by coalition building with tribal leaders and other health organizations, including the Indian Health Services (IHS) (Tobey et al., 2022). The development of such programs and integration of such interventions into the healthcare system, as well as educational training in terms of cultural sensitivity and diabetes management among healthcare practitioners are primary areas of concern because of which practice recommendations should be changed.

Timeline

The total period to be taken to complete the suggested project is less than six months. The project begins with a planning period, which takes one month, before the five months of mobilization. The community stakeholders and healthcare providers received training during the planning period of the implemented interventions. The registries concerning the diabetes education and lifestyle modification program implemented along with the mobile clinics and telemedicine services begin to work in the second and third months. The fourth and fifth months are associated with patient education, monitoring progress, and glycemic control feedback, which justifies the frequent workshops and involvement of the community (Karter et al., 2021). These activities are planned within the evaluation of the project outcome results in the 6th month to make adjustments and plan of action of future activities.

Tools and Resources Needed

The program will necessitate a mobile health workforce and telemedicine in distant locations, and community-specific educational materials. The community health workers and diabetes educators need additional training and regular maintenance to implement the intervention appropriately (Adams et al., 2020). In addition, local exercise and nutrition specialists, dietitians, and community centers are necessary in the project as well. Electronic health records (EHRs) will be employed during the data-gathering phase, and the progress and outcome monitoring of the patients will be carried out with the help of telehealth monitoring tools (Limketkai et al., 2021). The two tools are both realistically applicable to the patient care services to improve their longevity.

Stakeholders and Potential Barriers

Stakeholders

The stakeholders in this project are mainly the members of the diagnosed AI/AN type 2 diabetes community, the tribal elders, and the leaders. Nurses, physicians, community health representatives, and diabetes counselors will also be necessary in the implementation of the interventions (Marsh et al., 2021). The IHS, local health clinics, and public health agencies will be important partners that will provide some of the infrastructure and other resources towards the implementation of the project (Tobey et al., 2022). Policymakers, non profit making organizations, and funding bodies will undertake the sustaining and scaling of the project.

Opportunities for Innovation

The project can offer additional opportunities in the form of further development, such as the application of telemedicine and mobile health clinics in delivering diabetes care services to remote Indian AI/AN communities. Education, delivery of health services, and continuous monitoring of the patient can be improved with the help of technology applications, thus allowing personalized treatment to be offered at any specific place (Mbunge et al., 2021). The use of dieting and health beliefs culture in educating the patient in the form of books enhances adherence to treatments and attendance (Shapiro and Grajower, 2024). Similar to most projects, this project will be innovative in its approach to bridging the communication and trust between the AI/AN patients, who will have community health workers as the mediators.

Potential Barriers

There are some barriers that can disrupt the operation of this project. Stotz et al. (2023) contended that the issue of the healthcare services among the geographical AI/AN communities was an infrastructural intervention limitation. One of the issues raised in the research is the absence of patient involvement caused by culturally sensitive distrust, lack of understanding, and the inability to provide culturally sensitive care services. In addition to that, the limited resources provided by the community and the healthcare system contribute to additional woes, as the costs of mobile health units, telemedicine, and staffing are high. 

Specific Actions Taken to Overcome Barriers.

Services like mobile health units, telemedicine, etc will be used to address the geographical as well as infrastructural issues. The community gives it trust by relying on the engagement with tribal leaders and elders to commit to culturally respected methods (Farai et al., 2023). The communication and patient engagement will be enhanced by utilizing and engaging community health workers who are familiar with the AI/AN culture (Karter et al., 2021). The project will also consider utilizing government grants or non-profit organizations to some extent, yet making use of the already available resources at IHS to save a significant amount of money (Tobey et al., 2022). Language barriers will be overcome by the use of bilingual educational materials and interpreters to make information available to all members of the community.

Propose Outcome Criteria

The main outcome measures are the reduced level of HbA1c in the participants, which leads to the enhancement of glycemic control (Grace & Slyer, 2021). Other outcome measures encompass the level of patient participation in self-management interventions like turn up in educational programs, life change interventions including nutrition and exercise, and health care using telemedicine or mobile clinics. Additional indicators will be patient satisfaction with diabetes care and adherence (Grace & Slyer, 2021). These results will be evaluated by conducting routine health checks, surveys, and EHR data within a six-month period (Limketkai et al., 2021). Regular follow-ups of the patient will be taken to assess the progress, and the community health workers will check in regularly to make sure that any obstacles to care are overcome.

Alignment with Quadruple Aim and Policy Impact.

Such results are in line with the Quadruple Aim related to the population health (improved glycemic control and management of diabetes), patient experience (culturally-sensitive, accessible care), the per capita healthcare cost reduction (deterrence of diabetes complications), and the well-being of providers (through telemedicine) (Dehkordi et al., 2024). The outcome measures will deliver valuable evidence to inform subsequent practice, policy, and guidelines regarding culturally-sensitive, community-based interventions in the care of diabetes (Grace and Slyer, 2021). The information can guide larger healthcare policies to encourage more vulnerable populations to use mobile health services and culturally competent care, which will make healthcare practices more equitable.

Evidence Supporting Change

The data on the change in diabetes management among AI/AN populations proves the high differences in diabetes prevalence and outcomes among the population. Research evidence that has been stored in databases like PubMed, MEDLINE, and the Cochrane Library indicates that AI/AN populations face relatively high levels of type 2 diabetes because of socioeconomic factors and lifestyle (Chopra et al., 2022). Saenz et al. (2024) reported the benefit of personalised community-based interventions, particularly in diabetes education and management lead to better participation and higher blood sugar control as compared to traditional care. These results explain the deficit in efficient culturally specific interventions in managing diabetes in this specific population, which is already known to be high risk of adverse health complications.

A systematic review methodology was employed in the literature search strategy that incorporated the following search terms namely, a systematic review, diabetes management in AI/AN population, community-based approach, diabetes telemedicine, and culturally specific care. PubMed, MEDLINE, and Google Scholar were used to obtain the literature, with the publication not older than five years. As Hilty et al. (2021) noted, telemedicine, mobile health units, and culturally relevant educational programs were useful to enhance the diabetes outcomes of patients. This evidence is plausible and relevant in the sense that it shows the extra-burden that AI/AN populations in underserved communities carry, which is the reason behind the emphasized change of practice.

Conclusion

The PICOT is focused on the diabetes management initiatives among AI/AN populations with a focus on the activities, which are oriented at achieving community-level responses to certain inadequacies of care that are relevant to this population. The project aims to enhance the glycemic control and engagement in the more favorable health outcomes by developing a project that incorporates teaching, active lifestyle, and access to healthcare via innovative telemedicine methods. This will involve taking into consideration the available literature, the input of the concerned stakeholders, and producing a plan that strategically aligns with the Quadruple Aim, hence combating the diabetes problem in this population in a sustainable way.