Evidence – Based Practice proposal

Section – A

February 8, 2021

Section A

The place of employment is in an acute care hospital and usually dealing with the step-down patients. The facility is providing an intermediate level of care between the intensive care units and the general medical-surgical wards. The facility is handling different patients from different ethnic groups. The focus of the facility is to reduce the rate of common chronic illness such as type – 2 diabetes.

The healthcare providers promote healthy behaviors in the facility. For the patient with these chronic illnesses, the management is focused on supporting health behaviors approaches to reduce the risk of complications from these illnesses and reducing the risk of developing these illnesses. One of the strengths of the facility in relation to the promotion of healthy behaviors is that it focuses on patient education. At the healthcare facility of employment, even though the healthcare providers are focused on the promotion of healthy behaviors to help in the reduction of chronic illnesses like type 2 diabetes, there is a lack of the diabetic educator. There are no specialized exercise trainers in the facility to guide every patient on the type of exercise that they should be involved in to reduce the risk of developing the disease. Even though the facility does not have a diabetic educator, nurses play a significant role in educating the patient via written education, demonstration and verbal education. If it is not within the budget of the organization to have an onsite diabetic educator, nurses should be educated extensively and should be provided with tools necessary to educate diabetic patients effectively.

The facility is weaker when it comes to the follow-up especially when the patients are discharged from the facility. This is making it hard to ensure that patients are adhering to the practice guidelines and taking foods to ensure that they are free from exposure and complications associated with diabetes disease. The poor follow-up process is caused by the limited number of healthcare providers in the facility especially nurses and the increase in the number of patients seeking services in the facility. It will be recommended for the facility to follow up on the patients who are discharged from the facility to know if the community – based exercise program is working for them. Patients should be given a log to record daily blood sugar readings and information about the program so that effectiveness of the program can be understood. The nurse educator at the facility focuses on EBP and brings out EBP practices and explains to the nurse. For example, recently the educator started nurse driven protocols to remove foley catheters which is based on EBP. Nurses were given education in detail. Nurses and physicians provide patient care based on EBP. Only problem with the facility is that sometimes the administration doesn’t agree to some of the EBP and policies due to lack of resources and/or budget.

The organizational Culture & Readiness for System-Wide Integration of Evidence-based Practice Survey (Melnyk & Fineout-Overholt, 2014) was completed and showed that.

The health care providers working in the organization have a strong knowledge of EBP and provide patient care based on EBP. The healthcare workers work as a team to provide quality care to the patients. The culture of teamwork and the skills and knowledge of EBP among the health care workers, is one of the biggest strengths of the organization. The administration must include the staff during the decision making process on the units. The organization also lacks a library. A library in the organization can help the staff access EBP based journals and other useful information. This way the organization wouldn’t need to spend as many resources on education on EBP policies, repeatedly. Since most of the EBP related information can be accessed in the library.

Section B

One of the evidence-based practices that have been proposed is the community – based physical exercise program to help patients managing type 2 diabetes. The community follow-up process also requires an adequate number of healthcare workers. This implies that the implementation process of the community-based exercise is not effectively carried out thus affecting the overall goal that is aimed at ensuring that the chronic illnesses related to type 2 diabetes is dealt with accordingly. This therefore implies that the adoption or implementation of the community-based exercise program is not done as per the requirement in this facility to help in ensuring that there is a reduction in the weight and blood sugar levels.

Section B

PICOT

PICOT Question – Do the adult patients with type 2 diabetes (P) show improvement in their blood sugar levels and reduction in weight (O) with the help of community – based exercise program (I) as compare to patients who are unable to participate in the program (C) in an acute care facility, monitored over a 6 weeks period (T).

Literature Review

According to Akanni et al (2017), the dissemination of evidence-based programs is helpful in improving the health outcomes among the elderly population. It helps in understanding the factors that influence the community adoption of evidence-based programs. According to this study, Texercise Select is a community-based health promotion program that improves the functional health, the physical activity, nutritional habits, and the quality of life among adults. Such programs are cost-effective strategies that help in increasing the physical activities and improvement (Akanni et al. 2017).

Shirinzadeh et al (2019) performed a systematic review on the effects of community – based programs on diabetes prevention among the low and middle income nations. According to the authors, the community-based program that addresses physical activities is significantly beneficial in the prevention and management of type 2 diabetes mellitus especially in the high income nations. The study further indicates that community-based exercise program is positively impacting on the anthropometric indices and the HbA1C (Shirinzadeh et al., 2019).

Study by Mendes et al (2017) is focused on looking at how the implementation of the cheaper and community based exercise programs for the middle-aged and older patients with type 2 diabetes is beneficial to the control and management of diabetes and cardiovascular risk. The authors reveal that having a long-term, community-base, combined exercise program that is developed in a low-cost exercise approaches are effective in bringing about the control of the glycemic (Mendes et al., 2017).

According to Tan et al (2017), metabolic syndrome (MetS) together with its subclinical illnesses are becoming major public health concerns. The authors aimed at determining the impacts of the physical activity and the nutritional program for the reduction of MetS percentages. The outcome of the study revealed that community based physical activity is helping in the reduction of MetS percentage. It helps in the improvement of several metabolic and anthropometric parameters (Tran , et al., 2017).

Vanugopal et al (2017) aimed at evaluating the impacts of short term yoga-based lifestyle intervention in the management of diabetes and pre-diabetes within a pilot community-based research work. Based on the outcome of the study, it is evident that short-term yoga lifestyle intervention when implemented in the community is helping in the effective process of reducing the levels of fasting plasma glucose in type 2 diabetes and pre-diabetes (Venugopal et al., 2017).

Physical activity is one of the most important factors in reducing the risk of developing diabetes and reducing the complications related to diabetes. Research shows that when community – based programs are followed by type – 2 diabetic patients, there is a significant reduction in overall blood sugar levels and HbA1c. There are a lot of community – based programs available to the diabetic patients like Texercise, yoga or some other workout programs to suit a patient’s need and interest. But, the health care professionals have to make sure that the program is covered by insurance or has a minimal charge. At the same time, discussion with the patients is crucial before a patient is discharged from the hospital so that any barriers that patient might have, can be taken care of.

References

Melnyk, B. M; Fineout-Overholt, E. (2014, July). Grand Canyon university – digital resources. Retrieved February 04, 2021, from

http://gcumedia.com/digital-resources/wolters-kluwer/2014/evidence-based-practice-in-nursing-and-healthcare_a-guide-to-best-practice_ebook_3e.php

Akanni, O., Smith, M., & Ory, M. (2017, May 20). Cost-effectiveness of a community exercise and nutrition program for older adults: Texercise select. Retrieved February 03, 2021, from

Mendes, R., Sousa, N., & Reis, V. M. (2017). Implementing Low-Cost, Community-Based Exercise Programs for Middle-Aged and Older Patients with Type 2 Diabetes: What Are the Benefits for Glycemic Control and Cardiovascular Risk? International Journal of Environment Research and Public Health, 14(9), 1057.

Shirinzadeh, M., Afshin-Pour, B., Angeles, R., Gaber, J., & Agarwal, G. (2019). The effect of community-based programs on diabetes prevention in low- and middle-income countries: a systematic review and meta-analysis. Global Health, 15(1), 10. doi:10.1186/s12992-019-0451-4

Tran , V. D., James , A. P., Lee , A. H., Jancey, J., Howat , P. A., & Mal, L. M. (2017). Effectiveness of a Community-Based Physical Activity and Nutrition Behavior Intervention on Features of the Metabolic Syndrome: A Cluster-Randomized Controlled Trial. Metabolic Syndrome and Related Disorders, 15(2).

Venugopal, V., Rathi, A., & Raghuram, N. (2017). Effect of short-term yoga-based lifestyle intervention on plasma glucose levels in individuals with diabetes and pre-diabetes in the community. Diabetes & Metabolic Syndrome: Clinical Research and Reviews, 11(2), S597-S599.

Evidence – Based Practice Proposal

Section – C

February 9, 2021

Section C: Proposed Solution

The solution to the issue of concern is the community-based exercise/physical activity program. The effective process of managing diabetes mellitus among the population targets the process of changing unhealthy behaviors for example sedentary lifestyle and inactivity. People including those who have not yet been diagnosed with diabetes should be actively involved in the performance of aerobic exercise regularly. Aerobic activity bouts should be ideally taken at least 10 minutes with the objective of attaining 30 minutes per day or more. The community-based exercise/physical activity program is important since it targets neighborhoods, families, and other relevant social groups to help in increasing physical activity. The program involves the use of peer-support or group-based classes to promote a more active lifestyle among the targeted individuals (Collberg, et al., 2016).

The community-based exercise/physical activity program is realistic since it simply involves the dedication of time and commitment. According to Mendes et al (2017), the implementation of a community-based exercise program for middle and older patients with type 2 diabetes is cheaper. It helps in ensuring that the costly medication for the diabetes complication is prevented. It helps in the control and management of diabetes and cardiovascular risks. The development of a long-term community-based exercise program involves a lower cost (Mendes et al., 2017).

Some of the exercise activities such as yoga can be performed by individuals at their homes. Yoga can tackle the physiological aspect of diabetes and help to manage the disease and reduce the complication (Raveendran, Deshpandae, & Joshi, 2018). It is cheaper and involves a commitment of an individual to the program to help in the management and preventing exposure to diabetes. The short-term implementation of yoga-lifestyle is assisting in the reduction of the fasting plasma glucose among individuals with type 2 diabetes (Venugopal et al., 2017). good

Organizational Culture

The organization is committed to the improvement of the overall healthy behaviors to help in the reduction of the prevention of the exposure and management of chronic illnesses. One of the policies of the facility is to ensure that patients and the community population are empowered to actively take part in the management of their health. This is done through educating the patients on healthy nutrition and how to minimize the time being taken while seated or watching television. Parents are informed about the importance of ensuring that their children are restricted from over-spending their time watching television and taking fast foods. These activities and programs are therefore aligned to the community-based exercise/physical activity program since they are both aimed at improving the well-being and health of the population (Collberg, et al., 2016). good

The expected outcomes

There are several positive expectations from the successful implementation of the community-based exercise/physical activity program concerning the issue of diabetes. The expected outcome is the rapid drop in the incidence of type 2 diabetes and its complication. This, therefore, implies that there will be an improvement in the glycemic control, lipid profile, blood pressure, anthropometric profile, and reduction in the risk of coronary artery illness such as stroke and artery disease (Collberg, et al., 2016).

Method to achieve the outcomes

The first step in the implementation of the program is taking the baseline data in terms of sugar level range, the body weight, the HbA1C, the BMI, waist circumference, fitness test, values, muscular strength, and the values of HDL cholesterol will be taken. This is followed by the assessment of the individuals to help in designing the best type of exercise. This is followed by the training of the individuals by informing them about the frequency of the exercise, teaching them how to use the mobile applications to record their data for example blood sugar values before and after exercise. The individuals will then be allowed to take part in aerobic training, resistance exercise training, flexibility training, balance training, supervised and unsupervised training, and daily movement. The program continues for the next six months while the assessment on the effectiveness of the program by comparing the current and the previous values (Collberg, et al., 2016). Who will be doing all the measurements? Your clinic?

The potential barriers to the effective implementation are lack of time to take part in the exercise, lack of commitment, the inability of the participants to have access to the recommended foods since it might interfere with the effectiveness of the exercise concerning the glycemic values, and the lack of skills to use the applications on the mobile. It should not be assumed that all the individuals are well informed about the use of the application. Therefore, proper education and follow-up are required during the implementation process (Collberg, et al., 2016).

Outcome impact

The positive outcome from the implementation of the community-based exercise will be important in improving the quality healthcare outcome and well-being of the population. It will ensure that the population is empowered in managing their health and prevention of the risk factors. It will ensure that there are changes in the consumption habit and a reduction in the level of sedentary lifestyles. It will not only help in the reduction of the complication of diabetes and the risk of being diagnosed with type 2 diabetes but also reducing exposure to hypertension and obesity (Collberg, et al., 2016).

References

Collberg, S. C., Sigal, R. J., Yardley, J. E., Riddel, M. C., Dunstan, D. W., Dempsey, P. C., . . . Tate, D. F. (2016). Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. America Diabetes Association, 39(11), 206-2079. doi:10.2337/dc16-1728

Mendes, R., Sousa, N., & Reis, V. (2017). Implementing Low-Cost, Community-Based Exercise Programs for Middle-Aged and Older Patients with Type 2 Diabetes: What Are the Benefits for Glycemic Control and Cardiovascular Risk? International Journal of Environment Research and Public Health, 14(9), 1057. https://doi.org/10.3390/ijerph14091057

Venugopal, V., Rathi, A., & Raghuram, N. (2017). Effect of short-term yoga-based lifestyle intervention on plasma glucose levels in individuals with diabetes and pre-diabetes in the community. Diabetes & Metabolic Syndrome. Clinical Research and Reviews, 11(2), S597-S599. https://doi.org/10.1016/j.dsx.2017.04.010

Raveendran, A., Deshpandae, A., & Joshi, S. (2018, August 14). Therapeutic role of yoga in type 2 diabetes. Retrieved February 09, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145966/#:~:text=Yoga%20practices%20such%20as%20cleansing,in%20significant%20positive%20clinical%20outcomes.

EBP- Section D

February 10, 2021

Section D: The Selected Model or the Theoretical Framework

The project is based on the use of a community-based exercise/physical activity program to help in the management of type 2 diabetes. Physical activity is an important component of treating type 2 diabetes mellitus. However, to ensure that its associated morbidities are prevented, the physical activity requires an instant and long-term change of lifestyle. The utilization of the behavioral change theories like the trans-theoretical model is helping in the promotion of physical activity. According to this model, individuals vary in terms of their motivation and the progress through some stages of the motivational readiness towards the behavioral change. According to this model, people tend to utilize diverse approaches and methods at every stage of change (Kang & Kim, 2017).

This model is therefore important in the implementation of the community-based exercise/physical activity program through providing a framework that is used in the categorization of the individuals’ preparedness to the changes in their behaviors. It includes the stages that individuals have to take through to ensure that the habit of physical exercise becomes a norm. It helps in ensuring that there is the existence of self-efficacy and a successful process of change (Kleis et al., 2020).

Discussion of Each Stage in the Model

There are six sequential stages that involves the change process. In the pre-contemplation, the intention is not to take action in the next 6 months. Individuals are not well informed about the problems of their behaviors. In the contemplation stage, the intention is to start healthy behavior in the future i.e. 6 months. In this stage, people have discovered about the adviser impacts of their behaviors and have made a thoughtful consideration. In the preparation stage, there is determination and people are ready to engage in the action in the next 30 days. People are making necessary steps in changing their behaviors (Mettling et al., 2018).

In the action stage, there is a change in the behavior and there is an intention of keeping them. There is modification of the problem behaviors and the acquisition of the new and healthy behaviors. There is maintenance where there is sustenance of the behavior change for sometimes and there is an intention of maintaining them. There is an effort being made to prevent any relapse. In the termination stage, there is no desire of returning back to the unhealthy behaviors. The relapse is not accepted in this stage and therefore, individuals will stay in the maintenance stage (Kleis et al., 2020).

How the Stages would be Applied to the Proposed Implementation

Based on the intervention of the community-based exercise/physical activity program, the pre – contemplation stage is where the individual is still in a sedentary lifestyle and have no intention of changing or actively taking part in the physical exercise. (Appendix ?)Therefore, the focus would be to ensure that the sedentary lifestyle of individuals in the community is stopped. This is done by ensuring that the person is provided with the knowledge related to the adverse impact of the inactive lifestyle and watching television for several hours on their health. The individuals are also informed about the health benefits of active involvement in physical exercise (Kang & Kim, 2017). Comment by carma erickson-hurt: Cite your conceptual model here

In the contemplation stage, there is still a sedentary and 6-month intention, nevertheless, an individual have started to realize that their behavior might be problematic. Therefore, they have a thoughtful consideration of the advantages and disadvantages of changing the behavior with equal emphasis on both. This person is provided with the support to attain the desired change. They are helped to substitute unhealthy behavior with healthy behavior (Kleis et al., 2020).

In the preparation stage, there is irregular active physical exercise and still the intention. This step needed reinforcement through rewarding the positive behavior and penalty or taking the rewards for negative behaviors. In this case, the individuals can be motivated by praising them on how they have managed to attain certain physical fitness levels and body mass index (Kang & Kim, 2017).

In the action stage, there is regular activeness in the physical activities for the last 6 months. The individual has changed the behavior and is intending to maintain and move forward with that physical exercise activities. This step requires social liberation whereby the individual is made aware that active involvement in the physical exercise is a possible thing the person is supported by including them in the peer group to ensure that they remain motivated to take part in the physical activities (Kang & Kim, 2017).

In the maintenance stage, there is a regular activity for the long-term and there is no desire of returning to a sedentary lifestyle. This stage requires a re-engineering process and the environment is re-engineered to have the reminders as well as the cues that help in supporting and encouraging involvement in physical activities (Kang & Kim, 2017).

Appendix

Comment by carma erickson-hurt: The appendix is attached at the vey end of your final paper. Make sure this is specific to your project, so include the specifics of your project in each stage in this diagram

References

Kang, S., & Kim, Y. (2017). Application of the transtheoretical model to identify predictors of physical activity transition in university students. Revista de psicología del deporte, 26(3), 6-11.

Kleis, R. R., Hoch, M. C., Hong-Graham, R., & Hoch, J. M. (2020). The effectiveness of the transtheoretical model to improve physical activity in healthy adults: A systematic review. Journal of Physical Activity and Health, 18(1), 94-108. https://doi.org/10.1123/jpah.2020-0334

Mettling, S., Lee, J. M., Blount, A., & Dinkel, D. (2018). A Needs Assessment for Physical Activity Programming Based on the Transtheoretical Model. Recreational Sports Journal, 42(2), 202-216. https://doi.org/10.1123/rsj.2017-0019

EBP proposal – Section F

February 24, 2021

Section F – Evaluation Plan

The Methods to Collect the Data

The collection of the data on the values of the body weight, A1C, Body Mass Index, waist circumference, blood pressure levels, body fitness, the HDL levels, and the muscular strength will be iOS Applications which will then be transferred to the nurses or healthcare provider. This will help monitor the progress of the participants and guiding on the need to make necessary adjustments. One of the major aspects of recording the above data is to ensure that the participants are free from the risk of exposure to type 2 diabetes. The process of monitoring the above key values reveals the effectiveness of the physical exercise involvement. Therefore, the determination of the success of the physical exercise in controlling the body weight, BMI, waist circumference, and the HDL levels among others would show a reduction in the blood sugar level based on the records generated from the GlocoseZone or mySugr Application (Colberg, et al., 2016).

Outcome Measures Evaluate the Project Objectives

The focus of the physical exercise program is to help in the reduction of the risk of exposure to diabetes or any diabetic-related complications. The outcome of the values of the HDL, waist circumference, A1C, and blood pressure levels among others after the implementation is expected to reveal healthy levels that reduce the exposure of the participants to type 2 diabetes (Center for Disease Control and Prevention, n.d). Therefore, the successful implementation of the physical; exercise program is expected to record the lowest value of the blood sugar levels as compared to the baseline data i.e. the data generated before the implementation of the program. It is also expected that there will be an improvement in physical fitness, muscular strength, BMII, and the value of the A1C among others (Kordonouri & Riddel, 2019).

Outcomes Measured and Evaluated Based on Evidence

The recording of the values will be done using the iOS application on the phones of the patients. The records from the implementation program are done after getting the baseline data of each participant. The data on the key values will be recorded throughout implementation. Each participant will be actively involved in the type of physical activities designed for them based on their level of fitness (Cha, et al., 2017). Throughout this period, data on the HDL, body fitness, waist circumference, and A1C will be recorded. The records of these key values are recorded every 2 – 3 months and data like blood sugar values is recorded daily basis. The data is reported using the application and then forwarded to the healthcare provider. The daily recording of the blood glucose is also recorded and forward using other important applications such as GlocoseZone or mySugr Application. The reliability and the validity of the data or the outcome are attained by ensuring that the participants are knowledgeable about the use of the applications (Colberg, et al., 2016). The data will be reliable if patients are compliant and record the data regularly.

Strategies if Outcomes don’t have Positive Results

It is expected that there will be the recording of the reduced values of the blood glucose and improvement of other vitals such as the BMI and physical fitness. The negative outcome implies that adjustment is required, therefore, the values of the participants are compared. The individuals with no improvement are assessed for the consumption habit and a reduction and their sedentary lifestyles. These individuals are also assessed based on the challenges encountered so that necessary adjustments are made to enable them to benefit from the program (Kordonouri & Riddel, 2019).

The Implications of Practice to Future Research

The proposed evidence-based practice is important for future scholars who will be interested in studying the role of the community physical exercise program on the control of type 2 diabetes. The data generated will be used as the background study to guide on addressing the areas of limitations of this study to ensure that a community physical exercise program is implemented to benefit the population diagnosed with type 2 diabetes (Kordonouri & Riddel, 2019).

References

Center for Disease Control and Prevention. (n.d ). Diabetes Policy Brief: Providing Diabetes Self-Management Education and Support for Rural Americans. Retrieved from https://www.cdc.gov/ruralhealth/diabetes/policybrief.html

Cha, S. A., Lim, S. Y., Kim, K. R., Lee, E. Y., Kang, B., Choi, Y., & Ko, S. (2017). Community-based randomized controlled trial of diabetes prevention study for high- risk individuals of type 2 diabetes: lifestyle intervention using a web-based system. BMC Public Health, 17(1), 387. doi:https://doi.org/10.1186/s12889-017-4283-y

Colberg, S. C., Sigal, R. J., Yardley, J. E., Riddel, M. C., Dunstan, D. W., Dempsey, P. C., Horton, E S., Castorino, K., & Tate, D. F. (2016). Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. America Diabetes Association, 39(11), 2065-2079. doi:10.2337/dc16-1728

Kordonouri, O., & Riddel, M. C. (2019). Use of apps for physical activity in type 1 diabetes: current status and requirements for future development. Endocrinology and Metabolism, 10. doi:10.1177/2042018819839298