NURS FPX 9040 Assessment 3 VCI Summary 9040 with Presentation

Slide 1

• VCI Summary 9040 with Presentation

Hi, I am _____. Thank you all for attending my presentation of my doctoral project ‘Improving glycemic control in adult patients with type 2 diabetes using a structured follow-up protocol by the ADA. Through this project, the key importance of evidence-based nursing interventions, patient education, and collaboration among various disciplines was emphasized to enhance patient outcomes and improve healthcare quality. In this presentation I will share the project’s purpose, process, project findings, and implications for practice and care of patients through a nurse-led diabetes management program.

Slide 2

• Introduction

Our doctorate project was directed at enhancing glycemic control for adult patients with type 2 diabetes in an outpatient primary care clinic setting by implementing a diabetes follow-up protocol designed by the American Diabetes Association. A key clinical practice gap was the number of patients who had an HbA1c above 9% (42%) compared to the number that had an HbA1c below 7% (36%).

The aim of the project was to see if the 8-week nurse-led follow-up protocol would help gycaemic outcomes because it was based on ADA guidelines. The project’s goal was to obtain a clinically significant decrease in HBA1c, and this was accomplished with a 1.52% drop from 9.95% to 8.22% which is above the success criteria of no more than a 0.5% drop..

Slide 3

• Practice Problem and Clinical Significance

Diabetes gives a big trouble for the world public health, because glycemic control of type 2 diabetes is not good. Outpatient care setting, incomplete follow-up and low education levels often result in avoidable adverse outcomes: cardiovascular disease, neuropathy and kidney failure, and hospitalizations. Based on the doctoral project, a number of factors contributing to the poor diabetes management at the clinical site were identified. Factors cited were inconsistent scheduling practices, minimal use of electronic health record (EHR) reminders, inadequate multidisciplinary coordination and inadequate patient education. Doctoral projects in nursing often involve the translation of evidence into practice, to enhance the quality of healthcare and the outcomes of those receiving care. That objective was embodied by the intervention in the project, which included evidence-based nursing practices and organizational quality improvement strategies.

Slide 4

• Purpose of the Doctoral Project

The overall aim of the doctoral project was to establish if a structured ADA diabetes follow-up protocol could be used to improve glycemic outcomes for adults with type 2 diabetes in 8 weeks. The project focused on the identified gap of outpatient management of diabetes, which included inadequate follow-up, nonadherence to medications and lack of education on diabetes management on the patient’s end. Baseline assessment at the project site showed that 42% of patients had hemoglobin A1c (HbA1c) levels > 9% which is indicative of poor glycemic control. In addition, only 36% of the patients reached the recommended target level for HbA1c of < 7%, indicating a need for urgent action. These results were higher than the national figures for poor glycaemic control and revealed a marked lack of the implemention of current control strategies.  The project objectives were met. After implementing the intervention, the mean HbA1c dropped from 9.95% to 8.22% or 1.52 percentage points, which is a clinically significant decrease. This result was significantly below the project targets of a 2% or greater decrease in HbA1c. In addition, follow-up adherence was 89.2%, indicating high patient engagement and feasibility of operations.

Slide 5

• PICOT Question

The PICOT question for this project is: What difference will following the ADA diabetes follow-up protocol (I) make in glycemic control (O) for nursing staff caring for adult patients who have diabetes (P) as opposed to what is being done currently (C) over a time frame of 8 weeks (T)?

• Adult patients with Diabetes: Nursing Staff caring for them (P)
• ADA Diabetes Follow-up Protocol (I):
• C: Current Practices
• Affect Glycemic Control O:
• T: 8 weeks

Slide 6

• Evidence-Based Intervention

The intervention used in this project was an eight-week structured ADA diabetes follow-up protocol. The intervention consisted of several evidence-based components to enhance glycemic control and patient self-management behaviors. Nursing staff received educational sessions on the pathophysiology of diabetes, drug management, ways to educate patients, and documentation within the EHR. To enhance nursing competency and promote compliance to the clinical guidelines of ADA, simulation exercises, case-based learning and peer mentoring activities were integrated. The nursing staff and health care providers made visits to patients twice a week for follow-up. Nurses conducted blood glucose monitoring log reviews, medication adherence, individual education, and lifestyle changes (diet and exercise) during visits. Technology was also integrated with the project through other interventions, such as telehealth consultations and reminders in the EHR. These tools helped increase attendance at appointments, helped to communicate with patients and increased continuity of care for those facing transportation problems or scheduling issues.

Slide 7 and 8

• Outcomes of the Doctoral Project

The results of the doctoral research showed improvement in clinical, behavioural, and operational areas. The main outcome was the decrease in HbA1c levels of patients enrolled. After implementing the structured protocol for HbA1c follow-up, the mean HbA1c levels were reduced by 1.52 percentage points, reflecting clinically significant improvements in glycemic control. The following results support the effectiveness of the intervention: Several secondary outcomes were also in favor of the effectiveness of the intervention. The scores of nursing staff competency rose from 59.0% before training to 85.4% after the educational program. The competency scores of 7 out of 8 nursing staff participating scored higher than the 80% minimum score.

There was also a significant improvement in patients’ self-management behaviours over the project period. Nearly 70 % of the patients had complete adherence to the medications, and 65 % had a proper routine of blood glucose control. Moreover, compliance with the follow-up visits was high during the intervention, with 89.2% of the visits being accomplished. Just 10% of patients had HbA1c levels < 7% at the end of the 8 weeks, but the project showed significant short-term improvements with the possibility that it could yield longer-term improvements if implemented over a longer period.

Slide 9

• Contribution to Nursing Knowledge and Best Practices

The doctoral project made an important contribution to the knowledge and best practices in the field of chronic disease management for nursing. The project highlighted the critical role of nurse-led interventions in a structured manner to enhance patient care outcomes and emphasized the need for the incorporation of evidence-based intervention protocols into daily care practices. The project outcome results validated several relevant key health care practices, such as the use of standardized diabetes follow-up procedures, which result in better glycemic outcomes. Nurse-led teaching improves patients’ self-management approaches.  Furthermore, telehealth and EHR systems ensure better access and compliance with follow-ups. Structured competency development enhances the performance of nurses. There is interprofessional collaboration that improves continuity of care and quality of care provided.  Studies of doctoral nursing education underscore the need to develop evidence-informed solutions to enhance the delivery of health and health care services and the performance of health care organizations. The project also helped to advance the literature about quality improvement by proving that clinical education, technology integration, and patient-centered care can all work together and that patient-centered care can be effectively implemented in outpatient primary care.

Slide 10

• Key Audience Takeaways

The doctoral project offers several key takeaways for healthcare professionals, nursing leaders, educators, and healthcare organizations. For one, the project showed that evidence-based nurse-led interventions can be effective in improving chronic disease outcomes in a relatively short time. Structured follow-up care was associated with better glycaemic control, patient adherence, and competence of the nurses. Secondly, the project has emphasised the need for continuous and patient education and support for self-management. Patients who were consistently educated and reinforced with their actions had greater compliance with adhering to their medications and self-monitoring behaviors associated with blood glucose. Thirdly, the project highlighted the importance of technology in the management of chronic diseases. The increased availability of patients via telehealth, the increased follow-up rates through EHR reminders, and support for continuity of care. Fifth, the project demonstrated the value of working as an interdisciplinary team when addressing issues related to the improvement of health care quality. Successful implementation and continued engagement of patients was achieved through collaboration involving nursing staff, providers, care coordinators, and educators. Last, but not least, the project demonstrated the pivotal position of the leadership of nurses in organizational change, promotion of EBP, and enhancement of healthcare outcomes.

Slide 11

• Conclusion

The doctoral research project was successful as it demonstrated that structured diabetes follow-up led to significantly better glycemic control when delivered in an outpatient primary care setting with people with Type 2 Diabetes. The project led to substantial improvements in patient outcomes, nursing competence, and follow-up adherence, due to evidence-based practice, structured education, the use of telehealth, and teamwork. The project was able to accomplish its goal by reducing the average HbA1C level from 9.95% to 8.22%, and improving nursing competency scores and patient self-management behaviors. Findings highlighted the need for chronic disease management, nurse-led evidence-based quality improvement efforts, and contributed to nursing knowledge. Overall findings from the doctoral project were that with advanced nursing leadership, evidence-based practice, and systematic approaches to quality improvement, sustainable improvements in healthcare can be achieved in alignment with the delivery of the goals of the organization and the national standards for chronic disease management.