Poor adherence to treatment creates an acute problem in achieving favorable outcomes in patients diagnosed with diabetes mellitus. According to Ellis et al. (2018), diabetes ranked second out of seventeen chronic diseases in terms of low adherence and hospitalizations due to non-compliance with the treatment regimen. A significant contribution to the issue stems from the poor medical team performance resulting from insufficient awareness of both patients and medical staff.
Project Purpose Statement
The purpose of this project lies in improving adherence to diabetes treatment in primary care settings via the use of the Medisafe mobile app. The intermediate goals of the project are educating patients on the consequences of low adherence to treatment and improving provider-patient communication.
Background and Significance
Patients diagnosed with diabetes mellitus are inclined not to comply with the therapeutic regimen and often refuse to undergo treatment. According to Siddiqui et al. (2019), deviation from the prescribed regimen might happen due to the lack of opportunities or resources to undergo treatment offered by the clinic. Therefore, the treatment policy of the medical team directly contributes to the issue of low adherence to medications. Healthcare professionals must take an active approach in order to increase patients’ awareness of the consequences of low adherence to treatment. In addition, communication between the patients and the healthcare provider must be improved in order to enhance control over adherence to the prescribed regimen.
The use of a mobile app such as Medisafe would serve as an innovative solution to the problem. Healthcare providers would become able to establish stable contact with the patients, thus increasing their treatment adherence levels. According to Rezaei et al. (2019), the issue of low adherence often stems from the medical team’s inability to assess the developments and exert sufficient pressure on the patient. The use of a mobile app for frequent and rapid communication in diabetes treatment is expected to mitigate the problem and increase adherence levels.
PICOT-Formatted Clinical Project Questions
The framework of the project can be structured in the PICOT-formatted questions as presented below:
Population: patients of local primary healthcare organizations diagnosed with diabetes mellitus. The project population will be divided into control and intervention groups with an equal number of participants.
Intervention: the patients from the intervention group will install the Medisafe app on their smartphones under the doctor’s guidance. They will be instructed on how to use Medisafe for setting reminders and communicating with the medical team. Additionally, the patients from the intervention group will receive a detailed explanation of the negative consequences of low adherence to diabetes treatment. The control group members will receive a standard treatment without using the Medisafe app.
Comparison: After the project’s timeframe end, a treatment adherence percentage will be calculated for the control and intervention groups. In addition, adherence percentages will be calculated every week in order to obtain a dynamic picture of intervention effectiveness.
Outcomes: the adherence to diabetes treatment levels among the intervention group is expected to be significantly higher than in the control group due to enhanced communication and control via the mobile app.
Timeframe: the project will last 12 weeks in order to track the effectiveness of intervention in a relatively long period. Furthermore, the 12-week span would allow monitoring of the short-run changes in adherence to treatment.
References
Ellis, K., Mulnier, H., & Forbes, A. (2018). Perceptions of insulin use in type 2 diabetes in primary care: A thematic synthesis. BMC Family Practice, 19(1), 1-21. Web.
Rezaei, M., Valiee, S., Tahan, M., Ebtekar, F., & Gheshlagh, R. G. (2019). Barriers of medication adherence in patients with type-2 diabetes: A pilot qualitative study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 12, 589-599. Web.
Siddiqui, M. H., Khan, I. A., Moyeen, F., & Chaudhary, K. A. (2019). Identifying barriers to therapeutic adherence in type 2 diabetes: A complex and multidimensional clinical issue. Asploro Journal of Biomedical and Clinical Case Reports, 2019(1), 22. Web.
Diabetes is one of the most common chronic diseases at the moment. While disease management is associated with colossal direct health care costs, it also results in lower labor productivity in the population. For many years, there has been an active increase in the number of cases of diabetes of all types among the global population, which further aggravates the situation. The problem is relevant not only for the United States but also for other regions of the world. Diabetes has negative economic effects on both patients and society as a whole, making the increase in cases particularly threatening.
Diabetes management is a significant economic burden for both patients and the healthcare system. Sussman et al. (2020) note diabetes is associated with $ 237 billion annual medical expenses in the United States (p. 121). This figure represents 7% of the overall annual health care expenditures, which is more than any other chronic disease (Sussman et al., 2020, p. 121). It is also noteworthy that from 2007 to 2012, expenses increased by 41% (Hirsch & Morello, 2017, p. 231). Complications associated with diabetes are a major cause of death, morbidity, and financial burden that patients experience. Treatment is also a significant expense, as “in 2016, patients with type 1 diabetes spent $5700 per person on insulin, which accounted for 31% of the overall per-person spending for that year” (Sussman et al., 2020, p. 122). Thus, programs to prevent the development of diabetes and its associated complications are more beneficial than disease management for both patients and the healthcare system.
At the same time, the demographic and social characteristics of the modern population can be factors for the further deterioration of the situation. An aging population and the spread of obesity are contributing to an increase in the number of diabetic patients, whose number in 2017 reached 30.3 million in the United States alone (Hirsch & Morello, 2017, p. 231). In addition to increasing costs of disease management, patients suffering from complications often lose productivity, which also negatively affects their financial performance. This circumstance reduces the overall economic efficiency of the population due to lower work productivity, which could have been prevented. Afroz et al. (2020) note that “in 2017, an estimated US$89.9 billion was lost due to diabetes-related productivity losses in the USA” (p. 2). These numbers include losses due to premature death, presenteeism, and reduced labor force performance.
This situation is typical not only for the United States but is global in nature. For example, in South-East Asia, 88 million people between the ages of 20 and 79 have diabetes (Afroz et al., 2020, p. 1). It is estimated that in China, the equivalent of US $ 2.6 trillion is lost in GDP due to diabetes-related productivity loss, which is approximately US $ 45,959 per person (Afroz et al., 2020, p. 2). It is noteworthy that this problem affects not only high-income but also medium and low-income countries and continues to deteriorate. It is also critically important that rising direct health care costs result in higher taxes, which creates an additional burden on the population.
While type 2 diabetes occurs most often in adults, type 1 diabetes affects children and adolescents, which also increases costs. Mapa-Tassou et al. (2019) note that The number of cases of type 1 diabetes in children under 15 is growing rapidly, at an average of 3% annually (p. 2). While patients in more developed countries can receive timely care, in many African regions, limited access to treatment results in high mortality and morbidity rates. In Africa in 2017, 6% of deaths among the population aged 30 to 39 were due to diabetes (Mapa-Tassou et al., 2019, p. 2). Thus, in African countries, diabetes is dying of the working population, exacerbating the economic impact. As in other regions, African countries have colossal direct healthcare costs associated with diabetes, as well as indirect ones due to productivity losses.
An important effect of diabetes is also its impact on the life of individual members of society. In particular, patients may suffer from a persistent fear of complications or economic anxiety associated with disease management. In this situation, diabetes can become the cause of mental disorders, including depression. According to CDC (n.d), up to 50% of patients experience diabetes distress at any 18 months period (para. 14). The joint occurrence of these diseases negatively affects the management of each of them, which increases the risk of complications. These conditions lead to a potential increase in health care costs and an increase in the economic burden on patients.
Thus, diabetes is associated with negative economic effects due to direct and indirect costs. The growing number of cases around the world is a serious threat to the well-being of both developed and developing countries. Overall, diabetes leads to colossal health care costs, rising taxes, and losses in work productivity. Patients also face a significant financial burden due to the need to manage the disease and the complications that arise. Moreover, they may experience mental disturbances that further worsen the situation.
Hirsch, J. D., & Morello, C. C. (2017). Economic impact of and treatment options for type 2 diabetes. The American Journal of Managed Care, 23(13), 231-240.
Mapa-Tassou, C., Katte, J. C., Maadjhou, C. M., & Mbanya, J. C. (2019). Economic impact of diabetes in Africa. Current Diabetes Reports, 19(5), 1-8. Web.
Sussman, M., Benner, J., Haller, M. J., Rewers, M., & Griffiths, R. (2020). Estimated lifetime economic burden of type 1 diabetes. Diabetes Technology & Therapeutics, 22(2), 121-130. Web.
The phenomenon of diabetes prevalence in the US population has been a subject of discussion over the past several decades. In order to better understand the implications of the disease, it is necessary to dwell on both scientific and analytical aspects of type 2 diabetes mellitus (T2DM). The present paper focuses on the research questions related to the topic of T2DM prevalence in ethnic and social minorities. Hence, the Level 1 research questions for both inquiries are as follows:
What is the pathophysiology of T2DM?
What are the statistical facts related to T2DM prevalence in the US?
The Level 2 research questions are:
What are the pathophysiological implications of T2DM in minorities?
What are the statistical implications of T2DM in minorities?
Level 1 Research Questions
T2DM Pathophysiology
T2DM is generally known as a metabolic disorder that affects the global community disproportionally competed to other conditions. According to Galicia-Garcia et al. (2020), “its development is primarily caused by a combination of two main factors: defective insulin secretion by pancreatic β-cells and the inability of insulin-sensitive tissues to respond to insulin” (p. 1). Insulin is a crucial hormone for the human body because it regulates the levels of sugar in the blood by releasing glucose to the body to produce energy. Having low insulin release in the body, people have high blood glucose levels and experience issues with the heart, vasculature, sight, kidneys, and central nervous system (Galicia-Garcia et al., 2020, p. 2). Thus, in order to combat the disease, the patients need to regulate their insulin and blood sugar levels with the help of medical interventions or changes to their lifestyle.
There are many risk factors that can potentially lead to the development of T2DM. These factors include genetic predisposition to the disease, obesity, poor dietary habits, tobacco or alcohol dependence, or stress-related mental disorders (Yuan & Larsson, 2020). All these factors lead to a higher risk of low insulin secretion and the development of hyperglycemia, or extreme blood sugar levels. As far as the physiology is concerned, the organs usually involved in the T2DM development are “the pancreas (β-cells and α-cells), liver, skeletal muscle, kidneys, brain, small intestine, adipose tissue… adipokine dysregulation, inflammation, and abnormalities in gut microbiota” (Galicia-Garcia et al., 2020, p. 2). The development of T2DM frequently leads to comorbid diseases and health complications such as chronic obstructive pulmonary disease (COPD), depression, hypertension, coronary heart disease (CHD), and chronic kidney disease (CKD) (Nowalowska et al., 2019). Hence, T2DM is a serious health complication caused by various widespread factors and contributes to the development of other chronic conditions. For this reason, the management and early detection of this disease of crucial for effective health care nationwide.
T2DM Statistics
T2DM is rightfully considered one of the most widespread metabolic conditions in the US. Currently, nearly 37.3 million people in the country have diabetes, whereas 90-95% of this number is constituted by T2DM (Centers for Disease Control and Prevention [CDC], 2020a). The statistics, however, cannot be exhaustive due to the fact that with every tenth person having diabetes, one in five people are unaware of this diagnosis, making the number of T2DM patients potentially higher (CDC, 2020a). The rapid T2DM growth among the population results in more than $300 billion worth of lost employment and medical costs related to T2DM management (CDC, 2020a). Hence, it is reasonable to assume that diabetes is a global health issue that has become a full-scale epidemic in the US.
Regarding different population groups, the statistics demonstrate that T2DM is more prevalent in male older adults. Thus, nearly 26.8% of the US population older than 65 had diabetes in 2016 compared to 4.2% of diagnosed cases in the 18-44 age group (CDC, 2020b). Similarly, the number of diagnosed diabetes cases is 2% higher in the male population, constituting 14% of the US men (CDC, 2020b). The tendency, however, has a chance to change over time, as the CDC (2020b) notes that cases of T2DM in children increase significantly. Thus, in 2014-2015, the number of newly diagnosed T2DM cases in children aged 19 and younger was more than 5,000 (CDC, 2020b). Hence, considering the current statistics, it may be concluded that T2DM remains a major challenge to the US nation and requires more attention from the public health care institutions.
Level 2 Research Questions
Pathophysiological Implications of T2DM in Minorities
Previously, some of the common risks for developing T2DM were discussed, with genetic factors, obesity, inactive lifestyle, and stress being some of the most significant aspects. Thus, in the context of minority populations in the US, the pathophysiology of the disease remains the same, whereas the predisposition risks grow substantially. For example, since ethnic groups such as the Latinx population are more prone to develop obesity due to socio-economic factors and genetic predisposition, the risk of developing T2DM becomes higher compared to the White population. For example, in the study by Cruz and Granados (2018), the researchers claim that obesity disproportionally affects Latino youth in the US. Moreover, the study reveals that the physiological peculiarities of Latino youth imply higher liver fat accumulation and “low insulin sensitivity” (Cruz & Granados, 2018, p. 17). It puts them at a higher risk of hyperglycemia.
Another study by Goff (2019) suggests that the T2DM peculiarities are different for every ethnic background. For example, for the Asian population, the metabolism patterns are different from the White population. As a result, it is necessary to reconsider the threshold for the overweight BMI should be lower (Goff, 2019). Finally, the evidence also demonstrates that stress-related factors relate to the obesity predisposition in minorities. Corliss et al. (2018) suggest that the lesbian and bisexual population has a higher level of stress-related mental difficulties, leading to higher obesity levels and, eventually, T2DM risk. Hence, it may be concluded that socio-ethnic minority groups in the US, although developing the same anatomic patterns of T2DM, have a significantly higher risk of developing the disease through the underlying risks. Public health specialists need to develop cultural awareness and sensitivity framework to mitigate the problem’s scope.
Statistical Implications of T2DM in Minorities
When analyzing the national statistics on T2DM prevalence, it is evident that the majority of instances occur in minority groups. Thus, according to CDC (2020b), out of all the T2DM diagnoses recorded in 2017-2018 among local adults, only 7.5% of cases fall into the “non-Hispanic White” category. Other instances belong to “American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), non-Hispanic Blacks (11.7%), and non-Hispanic Asians (9.2%) (CDC, 2020b, p. 4). According to Goff (2019), “among minority ethnic communities, the prevalence is alarmingly high, approximately three to five times higher” than in White population (p. 930). Hence, it would be reasonable to assume that there is a distinct pattern of T2DM prevalence in ethnic populations, making it essential to rediscover the detection and management guidelines for the disease.
However, the striking statistical difference does not occur in different ethnic communities. Overwhelmed with the social pressure and stigmatization, lesbian and bisexual women are more prone to struggle with mental disorders and substance abuse. These factors, in their turn, contribute to higher levels of obesity. More precisely, the BMI mediation identified that lesbian and bisexual women “had a 27% higher risk of developing type 2 diabetes than heterosexual women,” especially at younger ages (Corliss et al., 2018, p. 1448). Hence, quantitative evidence demonstrates that nowadays, there is a major gap between the management and prevention of T2DM in minorities and the White cisgender straight population, mainly due to the lack of individualized and culturally sensitive care management.
Conclusion
The present paper focused on the two levels of research questions from the scientific and analytical perspectives on the matter of T2DM pathophysiology and prevalence in minorities. The answers to these questions lead to four primary outputs. First, T2DM is a complex metabolic condition that is characterized by low insulin release in the body and hyperglycemia. Secondly, the widespread risk factors for T2DM make it statistically one of the most common health conditions in the US. Thirdly, the increased predisposition to the risk factors and metabolic and cultural specifics makes minorities more physically vulnerable to T2DM. Finally, the statistics demonstrate that mental hardship, obesity, and different levels of insulin sensitivity and metabolism make the minorities’ risk of T2DM three to five times higher. Hence, it is of paramount importance to put more effort into the patterns of individualizing care for minorities.
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal of Molecular Sciences, 21(17), 6275.
Type 2 diabetes mellitus is a metabolic issue of late adulthood described by a reduction in glucose take-up from the blood and causing hyperglycemia (high glucose levels). For certain people, this prompts a physiological condition known as “insulin opposition” in which the chemical insulin turns out to be less viable at the process of bringing down glucose. Having acknowledged the significance of the disease and the potential consequences, it is necessary to discuss the management plan for diabetes centers and propose a methodology for data collection.
Research Problem
The recent findings demonstrate that there has been an increase in number of type 2 diabetes diagnoses. The overall amount of patients affected by the sickness is approximately 415 million people, and diabetes type 2 accounts for the majority of the cases (Chatterjee, Khunti & Davies, 2017). In general, such trends are observed due to the global increase in obesity rates and inactive lifestyles (Chatterjee et al. 2017). Therefore, the affected individuals should change their routine and incorporate exercises and proper diet. Nevertheless, in some cases, medical intervention is necessary, and the current paper attempts to analyze how the diabetes centers and governmental organizations manage the problem.
Research Objectives
Demonstrate the effects of type 2 diabetes and provide background information on the disease;
Discuss the management plans of diabetes centers and critically analyze the frameworks implemented in the hospitals;
Examine the existing methodology models and demonstrate the data collection methods.
Literature Review
As mentioned briefly before, the analyzed disease might cause long-term consequences on the patients. Approximately 33% of insulin opposition will evolve into persistent hyperglycemia and ultimately into type 2 diabetes (Chatterjee et al., 2017). Concerning the management in diabetes centers, the guidelines for healthcare services differ in various parts of the world. For instance, in the US, the American Diabetes Association (ADA) proposes guidelines for working with patients with diabetes (Chamberlain et al. 2017). These recommendations concern the types of diseases, pharmacological treatment, management plans, and even suggest the changes in lifestyles for patients (Chamberlain et al. 2017). From the management point of view, the guidelines provide an effective structure of medical care and stages of therapy (Chamberlain et al. 2017). Overall, the written regulations concerning the management plans might greatly enhance the effects of the therapy.
On the other hand, the American standards are not accepted universally in the world, and other countries implement their own guidelines. For instance, the Korean Diabetes Association provides slightly different recommendations concerning T2DM (Kim et al. 2019). Furthermore, a high number of independent researchers investigate the disease and provide innovative methods of treatment. For instance, Bus et al. suggest guidelines on the prevention of foot ulcers for the patients affected by T2DM (2019). At the same time, some experts focus on the management and assess the trends in hospital admission (Zhong, Juhaeri & Mayer-Davis, 2018). Ultimately, the collaborative effort of state-funded organizations and independent researchers might advance the current limitations.
Methodology
Research Design
The research design is primarily quantitative and implies specific objectives, methods, data collection, and statistics.
Sample size
Sampling is highly significant for effective research, and the sample size generally varies from several hundreds of respondents up to thousands.
Data Collection
Data is primarily gathered via interviews, observation, and surveys. In their research, Zhong et al. have utilized the CPRD, which is one of the largest databases of medical records (2018). In separate research, Karimi, Abedini, and Mohseni have implemented observation and questioning as their primary source of data collection (2017). Overall, the gathering of the information is the crucial point of the study, and quantitative research generally operates the aforementioned methods.
Questioning
A questionnaire is a significant component of quantitative research and might heavily influence the results of the study. For instance, in the study of behavioral patterns of patients with T2DM, the authors have comprised a questionnaire of two separate sections concerning the survey, included three groups of people with different backgrounds and health complications, and lifestyles (Karimi et al. 2017). Based on these criteria, the authors have designed the questions accordingly to achieve the most illustrative and transparent results. In the research of foot ulcers in patients with T2DM, the authors have also utilized the PICO (Patient-Intervention-Comparison-Outcome) methodology which consists of a systematic questioning of the patients (Bus et al. 2019). Overall, surveys are highly effective to gather information and build a solid foundation for the research.
Observation
Observation is another method of data collection that is frequently utilized in data collection in medical research. This model is particularly effective to recognize the behavioral patterns and their influence on the health of the patients. Additionally, this method might be implemented to draw conclusions concerning the management of diabetes centers and other hospitals. Nevertheless, this model has several limitations and operates better in combination with other frameworks.
Conclusion
Overall, the current paper has provided background information on type 2 diabetes mellitus, examined the management plans of diabetes centers and the provided guidelines, and analyzed the primary models of data collection in the methodology section. T2DM is a severe disease that requires improvements in both clinical and management aspects of healthcare. Therefore, it is essential to continually conduct research to get insights into innovative methods of treatment and effective management plans.
Reference
Bus., S., Lavery, L., Monteiro-Soares, M., Rasmussen, A., Raspovic, A., Sacco, I., & van Netten, J. (2019). Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes & Metabolism Research and Reviews, 36, Web.
Chamberlain, J. J., Herman, W. H., Leal, S., Rhinehart, A. S., Shubrook, J. H., Skolnik, N., & Kalyani, R. R. (2017). Pharmacologic therapy for type 2 diabetes: Synopsis of the 2017 American Diabetes Association standards of medical care in diabetes. Annals of Internal Medicine, 166(8), 572. Web.
Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085), 2239-2251, Web.
Kim, M. K., Ko, S. –H., Kim, B. –Y., Kang, E. S., Noh, J., Kim, S. –K., Park. S. –O, Hur, K., Chon, S., Moon, M., Kim, N., Kim, S., Rhee, S., Lee, K., Kim., Rhee, E., Chun, S., Yu, S., Kim, D., Kwon, H., Park, K., & Korean Diabetes Association. (2019). 2019 clinical practice guidelines for type 2 diabetes mellitus in Korea. Diabetes & Metabolism Journal, 43, 398-406, Web.
Zhong, V. W., Juhaeri, J., & Mayer-Davis, E. J. (2018). Trends in hospital admission for diabetic ketoacidosis in adults with type 1 and type 2 diabetes in England, 1998–2013: A retrospective cohort study. Diabetes Care, 41(9), 1870–1877. Web.
The intervention tool used in the study is a mobile app called BlueStar, designed for self-management of Type 2 diabetes (T2DM). It is created to act like the patient’s virtual coach by collecting information such as daily glucose readings, baseline health data, exercise records, and food intake (Agarwal et al., 2019). Once a patient enters this data, the app uses it to generate affirmatory or educational content delivered as messages. At the same time, it transmits the information to a health professional who can take further action as needed.
Patient Population
The population involved in the study included adults who are 18 years and above with T2DM. At recruitment, they must have been participating in selected DEPs (Agarwal et al., 2019). All participants must have had the ability to use email through their phones or computers. However, patients with type 1 diabetes, pregnant, under ongoing glucose monitoring, using insulin pumps, on dialysis, and those who cannot use a phone or computer were excluded from the study.
Main Idea of the Study
The central focus of the study was to assess the effectiveness of the BlueStar app in controlling glucose levels among the participants. However, the researchers also measured improvement in self-management, health utilization, and the patient’s experience with care (Agarwal et al., 2019). The study also recorded and evaluated the participant’s utilization of the BlueStar app.
Research Findings
The researchers reported low usage of the mobile app among participants. Even when the app was logged in, there was poor utilization of its features. Therefore, there was no significant difference between the control and experimental groups in glucose control (Agarwal et al., 2019). However, a few of the participants actively used their apps and all the features, reporting an improvement of 0.4% in glycemic control after the first 25 days (Agarwal et al., 2019). The researchers reported several contextual factors that influenced app usage, including clinician and patient training before participation and installing the app on a second phone.
Integrating the Mobile App in Nursing
Mobile applications are revolutionizing self-care and management for chronic illnesses. Agarwal et al. (2019) established that trained patients reported high rates of logging in and utilization of the app features, which led to lower HbA1c levels. Therefore, nurses would require training and, in turn, train all new app users properly. Agarwal et al. (2019) also found that newly diagnosed patients had high app utilization rate than those who have been in management for over six months. Hence, nurses must ensure that every newly diagnosed T2DM patient is immediately trained and signed up for mobile app usage. With the burgeoning patient population and increasing staff shortage, supporting NDS with mobile apps would release nurses to attend to more critically ill patients (Jiang et al., 2022). Besides, Jiang et al. (2022) reported that there is no difference in health indicators between patients on NDS and those using mobile apps. Therefore, nurses can effectively use mobile apps to support T2DM self-management.
Cultural Aspect of Diabetes
Although diabetes affects every human race, it is more prevalent among minority groups in the US. According to Cervoni (2021), Blacks, American Indians, Hispanics, and Asian Americans report the highest rates. The data shows that Alaskan Natives or American Indians are leading with a 14.7% prevalence, followed by Hispanics with 12.5%, non-Hispanic Blacks with 11.7%, Asian Americans with 9.2%, and non-Hispanic Whites with 7.5% (Cervoni, 2021). Since diabetes education is central to efficacy in self-management, nurses must learn to incorporate cultural knowledge into the exercise and content (Ung, 2017). In addition, cultural sensitivity and awareness should be demonstrated during interactions with patients.
Offering Cultural Support
To offer cultural support to diabetes patients requires the nurse to learn the various cultural backgrounds of the patients. The interaction should begin with the establishment of a good rapport to create the trust that will enable the nurse to get as much information as possible from the patient (Ung, 2017). Important cultural factors in diabetes management include food, eating habits, medication beliefs, and alternative medicines (Cervoni, 2021). Nurses must understand how each culture perceives food and their eating beliefs. Most especially, nurses should ensure that patients know carbohydrate sources in their traditional cuisines, as it is the most important macronutrient in diabetes management (Cervoni, 2021). Culture also dictates and influences family input into the patients eating and self-care routine.
Psychological Aspect of Diabetes
Psychological factors in diabetes management focus on the patient’s emotions and motivations toward the healthcare system and their illness. Ung (2017) listed specific factors relevant to diabetes patients as self-efficacy, perceived social support, and depression systems. These aspects will influence a patient’s adherence to treatment and dietary plans.
Providing Psychological Support
Psychological support is crucial in ensuring patients adhere to treatment and diet plans. A psychological assessment will reveal the reasons why a patient is non-adherent. Diabetes self-management education (DSME) should be used to overcome psychological barriers to achieving optimum outcomes (Ung, 2017). When such education is availed, it should focus on establishing behavioral goals with the patient, continuously supporting them, using psychosocial strategies in treatment plans, and utilizing age-appropriate programs (Ung, 2017). Therefore, DSME is a critical component of dealing with cultural, psychological, and spiritual aspects of diabetes management.
Spiritual Aspect of Diabetes
Religious beliefs and spirituality are universal themes for human beings. According to Onyishi et al. (2021), spirituality is positively linked to diabetes management as it creates a generally positive attitude toward life. Religious practices also influence individual adaptations positively, wile rituals conducted at places of worship decrease stress levels (Onyishi et al., 2021). Gatherings at worship places also offer social and mental support to patients because of the positivity in the atmosphere and general kindness from members. There are faith-based interventions (FBIs) that nurses can use to support T2DM, depending on their religion and spiritual beliefs.
Faith-Based Interventions
Nurses can pursue various FBIs depending on the patient’s openness and religion. Practical and effective techniques include rituals, meditation, sacred and journal writings, focusing, and voluntary fasting (Onyishi et al., 2021). Each of these methods may be more acceptable to one religion than to the other. However, each religion has one or more techniques as practice in their groups. For example, Christian patients would accept prayers, voluntary fasting, and meditation. Overall, most mainstream religions will be allowable to all of these methods. Nevertheless, nurses must be sensitive to religious beliefs that interfere with treatment plans.
Conclusion
The study evaluated was conducted to test the effectiveness of using a mobile app for T2DM management. It showed that only active use of such devices would yield positive results. Training and education are necessary before signing up patients to encourage a high utilization rate. Nurses can use mobile apps to reduce their workload and effectively manage their T2DM patients. Since cultural and psychological factors influence diabetes management, nurses must learn how to be sensitive and utilize these factors in their favor. Spirituality and religious practices produce outcomes that enhance diabetes management. Nurses can rely on FBIs, such as prayers and fasting, to improve patients’ outcomes.
References
Agarwal, P., Mukerji, G., Desveaux, L., Ivers, N. M., Bhattacharyya, O., Hensel, J. M., Shaw, J., Bouck, Z., Jamieson, T., Onabajo, N., Cooper, M., Marani, H., Jeffs, L., & Bhatia, R. S. (2019). Mobile app for improved self-management of type 2 diabetes: Multicenter pragmatic randomized controlled trial. JMIR Mhealth and Uhealth, 7(1), 1-13. Web.
Cervoni, B. (2021). Cultural considerations in diabetes management. Very Well Health. Web.
Diabetes, being the seventh cause of death in the United States, is a complex condition that, apart from being dangerous on its own, serves as a contributing condition to such severe diseases as cancer, kidney and liver diseases, and dementia (Centers for Disease Control and Prevention [CDC], 2019). For this reason, there is a need to develop an extensive framework for preventing diabetes, especially with more than 80 million US residents living with prediabetes (CDC, 2020). The latter stands for the phenomenon of people having high blood sugar rates, but such an amount of blood sugar cannot be yet justified as diabetes per se. In the research conducted by Moin et al. (2018), the authors attempted to define the scope of efficiency of such a tool as an online diabetes prevention program in the prevention of diabetes among obese/overweight population with prediabetes.
Intervention tool
The intervention tool chosen for the study by Moin et al. (2018) is an online diabetes prevention program (DPP) that focuses on the reduction of diabetes risk, including excessive weight, lack of physical activity, and poor nutrition. The primary motivation to create this tool is based on the limitation that many people with prediabetes cannot be reached in person, so they fail to receive meaningful intervention and quality education on diabetes prevention. According to Moin et al. (2018), online DPP is “a 12-month intensive lifestyle intervention with weekly modules (educational materials on healthy eating and exercise) delivered asynchronously through a web-based platform” (p. 586). The primary premise of the program is to provide patients with prediabetes with a web-based platform curated by professional health mentors specializing in nutrition, psychology, and exercise physiology.
Patient population
The population of the present non-randomized trial encompassed three groups of people with prediabetes recruited from the Veterans Administration. The population of the research was divided into three major groups: online DPP, in-person DPP, and the Administration’s personal program on weight loss called MOVE! (Moin et al., 2018). The first two groups constituted approximately 260-275 people each, with the MOVE! program being half as much. Over the course of a year-long intervention, the participants were divided into groups in order to secure peer support and a sense of community. The participation included a series of online meetings with coaches and video materials on the matter of physical and nutritional education.
Main findings
The primary goal of the intervention was to enhance the inclusiveness in terms of access to educational resources, peer and educational support for the patients unable to reach out to the assisting resources in person. Hence, in the process of the trial, the researchers aimed at identifying the extent to which online intervention could replace real-life education and progress tracking. Based on such variables as weight loss and the average amount of physical activity calculated in minutes, it was established that online DPP secures the same efficiency rates as the other interventions, making it a relevant and beneficial alternative for people unable to reach out to the professionals personally (Moin et al., 2018). Hence, the findings of this study demonstrate that the implementation of online DPP can become an asset in terms of diabetes prevention among the ones who have a predisposition to the development of this condition at some point in life.
Integration
The implementation of online DPP may be beneficial for people with prediabetes as well as the ones who are at moderate risk of the condition emergence. For example, if it is identified over the course of physical assessment that the patient has a genetic predisposition to the condition, excessive weight, or has irregular and unhealthy eating habits, the patient may be at moderate risk of diabetes development. The introduction of online DPP, in this case, may serve as a beneficial educational and health-promoting tool that does not require regular in-person checkups and interactions with doctors. By receiving wireless scales and access to the educational materials, the patients gain autonomy over their health, but they have the ability to reach out to their physician if they realize they require additional assistance. Hence, this tool may be implemented as a beneficial risk-reduction tool.
Besides reducing primary risks, online DPP is a beneficial tool to manage people with prediabetes or already existing diabetes. Indeed, the control of overweight, nutrition, and physical activity are critical in terms of maintaining normal health conditions and avoiding health complications. For this reason, this tool should be introduced to diabetes patients along with the existing medical treatment and in-person cooperation with the treating physician. In such a way, the patients will be able to have constant access to control over their well-being, as in most situations, it is physically impossible to communicate with one’s physician every day on the matter of weight management progress or the amount of physical activity, By recording these data on the web-based resource, the doctor will have the ability to connect the patient’s condition during the checkup, their blood sugar rate, and the daily patterns of physical activity and diet in order to reconsider the existing treatment and interventions. In essence, online DPP is an additional beneficial tool for both primary and secondary prevention of diabetes.
Psychological aspects of diabetes
Diabetes has a severe psychological strain on the patient due to two primary reasons: self-management and social perception. Indeed, the modern social context fails to recognize diabetes as a serious health condition it is, as the notion of diabetes is stigmatized with the idea that people living with the disease are unable to control their dietary habits and consume many sugary products (Davies, 2019). Moreover, diabetes management puts much responsibility on the individual, as they become in charge of their lifestyle in order to prevent further complications. In this case, it is the nurse’s primary responsibility to provide support and assistance while supporting the patient’s autonomy (Davies, 2019).
Cultural aspects of diabetes
The cultural aspect of diabetes is also important to consider, as this disease is currently more prevalent in ethnic and racial minorities (Moin et al., 2018). For this reason, ethnically diverse patients may be at higher risk of developing diabetes over the life course. It is also crucial for the practitioners to design culturally sensitive interventions regarding the lifestyle and nutrition habits peculiar to a certain ethnic group.
Spiritual aspects of diabetes
Religiosity also plays a significant role in diabetes management, as many people find spiritual beliefs a motivation to come to terms with their disease and value their life. According to Darvyri et al. (2018), “participation in church and spiritual beliefs, which imply the belief in the existence of God, seems to have an ameliorating effect on stress levels and, thus, on glycemic control of these patients” (p. 740). For this reason, nurses should encourage the patients to reach out to the patient’s spiritual communities to find support and rediscover the value of human life.
Conclusion
Diabetes is a highly complex and challenging healthcare condition that requires constant control over one’s habits and lifestyle. The intervention presented in the study may become an asset in terms of assisting such control and education on the matter. Moreover, the facilitation of self-management contributes to the better psychological condition of the patient, which impacts the patient’s progress.
References
Centers for Disease Control and Prevention [CDC]. (2019). Diabetes report card[PDF document]. Web.
Moin, T., Damschroder, L. J., AuYoung, M., Maciejewski, M. L., Havens, K., Ertl, K., Vasti, E., Weinreb, J. E., Steinle, N. I., Billington, C. J., Hughes, M., Makki, F., Youles, B., Holleman, R. G., Kim, H. M., Kinsinger, L. S., & Richardson, C. R. (2018). Results from a trial of an online diabetes prevention program intervention.American Journal of Preventive Medicine, 55(5), 583–591. Web.
This journal evaluates the perception of diabetes patients on insulin therapy and treatment. They administered an online cross-section survey to people with diabetes who received oral glucose alone and basal insulin for more than two months and recorded the effects insulin had on their bodies. I will use this source to support my research because the perception of diabetes patients on insulin therapy is essential for understanding the impact they cause on the person.
The text explores the importance of insulin-based acute treatment among diabetic patients. Insulin is known to promote glucose consumption as the primary source of energy that affects people with diabetes. This journal will help advance my research as it precisely identifies the effects of insulin on patients through controlled clinical methods. In addition, I will link it to my study since there is a strong background between insulin and diabetic patients.
Melo et al. discussed the effect of short-acting insulin on patients with type 1 diabetes (T1DM). The results of insulin on weight gain and the high incidence of hypoglycemia are deeply analyzed. This research is relevant to my study because it develops insulin analogs through modification to understand its effects on T1DM. I will use this study to build my literature review on the results of insulin in diabetic persons.
In this work, Penno examined insulin resistance in a patient with diabetes and its relation to other body parts such as the kidney. The authors noted that insulin sensitivity was associated with all a cause of mortality in type 2 diabetes through an observational perspective. This association will be beneficial as I explore the effects of insulin in diabetic persons. The report presents a close relationship on the impact insulin has on the body of a person with type 2 diabetes that I will use to develop my research.
The article presents the association between insulin and diabetic people and the mortality prevalence among patients with liver cirrhosis. Though insulin is recommended for the management of diabetes among patients, its long-term effect on these people is adverse as it increases the risk of death. I will use this study to support my research as there is substantial background on why insulin is recommended for diabetic management and its long-term effects.
Works Cited
Cosson, Emmanuel, et al. “Perceptions of Insulin Therapy in People with Type 2 Diabetes and Physicians: A Cross-Sectional Survey Conducted in France.” Patient Preference and Adherence, vol. 13, 2019, pp. 251-260.
Daoud Naccache, Deeb, Sergey Yalonetsky, and Ronen Bar-Yoseph. “Acute Effects of Insulin on Cardiac Function in Patients with Diabetes Mellitus: Clinical Applicability and Feasibility.” International Journal of Endocrinology, vol. 2020, 2020, pp. 8134548-8.
Melo, Karla F. S., et al. “Short-Acting Insulin Analogues Versus Regular Human Insulin on Postprandial Glucose and Hypoglycemia in Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis.” Diabetology and Metabolic Syndrome, vol. 11, no. 1, 2019, pp. 2-2.
Penno, Giuseppe, et al. “Insulin Resistance, Diabetic Kidney Disease, and all-Cause Mortality in Individuals with Type 2 Diabetes: A Prospective Cohort Study.” BMC Medicine, vol. 19, no. 1, 2021, pp. 66-66.
Yen, Fu-Shun, et al. “Is Insulin the Preferred Treatment in Persons with Type 2 Diabetes and Liver Cirrhosis?” BMC Gastroenterology, vol. 21, no. 1, 2021, pp. 1-263.
This presentation not only develops a community health nursing intervention and evaluation tool for the diabetes problem affecting Country Walk community, but also identifies the various elements of the nursing process as the apply to this particular community.
Country Walk, an urban neighborhood located in Miami-Dade County (MDC), contains a unique mix of occupational and cultural groups.
An analysis of demographic, epidemiological and windshield survey assessment data revealed that diabetes is a serious health nursing problem in the community that warrants to be prioritized.
The high incidence of diabetes in the community is due to its mainly Hispanic population: 26.4% South American; 26.1% Cuban; and 4.7% Mexican (About Country Walk, 2016).
Findings of the assessment shows diabetes to be a problem in the community due to:
Entrenched racial beliefs;
Obesity (23.9% are obese);
Poor diet choices (e.g., low intake of fruits and vegetables);
Lack of physical activity (21% are inactive);
High blood pressure (24.2% of the population);
High cholesterol levels.
Proposed Intervention
Intervention
The outreach intervention will be used to address the obesity issues and poor diet choices related to the incidence of diabetes in the community.
The outreach intervention “locates populations-of-interest and provides information about the nature of the concern, what can be done about it, and how services can be obtained” (Public Health Interventions, 2001, p. 41).
The outreach intervention fits well in the public health intervention wheel , particularly in terms of “describing the scope of practice by what is similar across settings and describing the work of public health nursing at the community and systems practice levels as well the conventional individual/family level” (Public Health Interventions, 2001, p. 1).
“Outreach is one of 17 interventions in the Public Health Intervention Wheel (above figure), which provides a model for understanding the work of PHNs” (Tembreull & Schaffer, 2005, p. 347). “The interventions on the Intervention Wheel were initially developed through a grounded theory process and then critiqued by public health nursing experts, resulting in basic steps and best practices for 17 interventions” (Tembreull & Schaffer, 2005, p. 347)
Target Population and Target Methods
Intervention will be community based, and will target Hispanic adolescents (13-19 years) most at risk for becoming obese and developing associated health concerns due to poor dietary habits.
Intervention will target schools, churches and local media outlets.
Aim is to repeat the intervention several times (at least thrice per month for six months) through the use of various communication outlets (e.g., local community radio, school lectures, church sermons, etc) to reinforce behavior modification.
Famous personalities (e.g., sportsmen and models) and lay health workers (LHWs) will be used to disseminate innovative, carefully designed materials and messages in radio call-in programs, local schools and churches (messages should be age-specific and culturally-appropriate).
Strategies & Materials Used
Community forums.
Community and school fairs.
Brochures (age-specific and culturally-appropriate).
Pushcards.
Radio call-ins hosted by influential personalities.
To encourage participation, radio call-in programs will run for four weeks after commencement and brochures will include hotline numbers which community members can use to ask for clarifications. Popular personalities will be used to increase appeal.
Setting and Role of Community Health Nurse
The community health nurse setting that will be in charge of rolling out the intervention is the nutrition promotion unit at the local health department.
The community health nurse in this unit will be charged with the following responsibilities:
“identifying the issues to be addressed”;
“describing the main characteristics of the target population”;
“analyzing how demographic and other information may be used to develop an effective outreach”.
Roles of community health nurse
“testing the outreach plan to see if it communicates the right message”.
“implementing and monitoring the outreach plan”.
“evaluating the results of the outreach implementation”.
“identifying external and internal barriers to the outreach plan and seeking ways to address them” (Tembreull & Schaffer, 2005, p. 347).
Collaboration and Strategy
The outreach program aims to collaborate with local media personalities, lay health workers (LHWs), church leaders, school heads, and motivational speakers to achieve effectiveness and wide coverage. Prominent community members will also be asked to volunteer in creating awareness.
A primary prevention strategy will be used to promote health among Hispanic adolescents (e.g., by demonstrating the importance of consuming fruits and vegetables, reducing the intake of fatty foods, and engaging in routine physical exercises) and also to protect against threats to health.
Pictures of Outreach Intervention Programs in Session.
Intervention Justification
The problem of diabetes is a priority based on the fact that individuals of Hispanic descent not only suffer higher rates of morbidity and mortality related to diabetes than non-Hispanic white people, but are more likely to develop diabetic-related complications (e.g., retinopathy, kidney disease, and lower limb amputation) than other ethnic groups in the population (Hatcher & Whitemore, 2007).
Outreach interventions are highly effective in effecting behavior change, especially if such interventions use a combination of lay health workers (LHWs) and famous personalities to communicate the message.
One study found that the use of LHWs in community-based outreach programs is an effective strategy to increase cancer screening behaviors in underserved or vulnerable ethnic populations (Nguyen, Stewart, Nguyen, Bui-Tong, & McPhee, 2015).
Although LHWs are not health care professionals , they nevertheless receive some training to promote health and hence can be effectively incorporated into outreach programs meant to modify behavior among the targeted populations.
This study found that LHW outreach intervention is effective as social networks provide “the existing relationships, trust, and social and cultural norms among the network members for LHWs to rely on for influencing the participants to obtain CRC [Colorectal cancer] screening” (Nguyen et al., 2015, p. 2086).
Another study argues that public health nurses (PHNs) can “use the intervention of outreach to improve health status by locating at-risk or of interest populations, providing information about health concerns and linking the population to resources to address the health concerns” (Tembreull & Schaffer, 2005, p. 347).
Findings of another study demonstrated that “culturally specific outreach materials based on personal narratives are a promising population-based intervention to motivate rural smokers to consider cessation” (Butler et al., 2013, p. 44).
The authors of this study also contend that outreach interventions are effective in reaching special populations, incorporating community-based participatory strategies needed to modify health behavior, and establishing equitable relationships with diverse community members with the view to cultivating an enabling environment for behavior change.
Based on the findings of the reviewed studies, it is evident that the outreach intervention is an effective approach that can be used to modify the behaviors of Hispanic adolescents in the community.
Proposed Evaluation Method
Method
Interviews will be conducted with selected Hispanic adolescents pre and post intervention.
This method is qualitative in approach.
Interviews provide deep and insightful information related to people’s attitudes, value systems, perceptions, and world views (Turpin, Asano, & Finlayson, 2015).
Although they are time-consuming and costly to undertake, they represent the best approach to understand how the intervention has modified the behavior of Hispanic adolescents from their “own” description of personal experiences.
Desired Outcomes
Behavior change to reinforce healthy habits.
Increased consumption of fruits and vegetables among the targeted population.
Increased enrollment to physical exercise programs within the community.
Decreased intake of fatty foods.
Routine observance of body weight.
Reinforcement of health-seeking behaviors among the targeted population (e.g., routine visits to health clinics for medical checkups.
Sample Interview Questions (post-Intervention)
Can you describe how your consumption of fruits and vegetables have changed after participating in the outreach intervention?
Has your attitude towards engaging in physical exercises changed and, if yes, how has the change assisted you to maintain a healthy body weight and lifestyle?
What is your attitude towards the consumption of fatty and unhealthy foods?
How has the intervention affected your behavior in terms of seeking help for common medical complications?
Short-term Impact
If the intervention is successful, it will minimize hospital visits and other morbidities/disabilities associated with poor dietary habits and lack of physical exercises.
The community will also have a healthy population which is aware of adverse health outcomes associated with poor dietary habits and lack of physical exercises.
Long-term Impact
Cases of diabetes in the community will decrease as community members will be well endowed with the knowledge of how to address the risk factors associated with the disease.
Community members will live longer and quality of life indicators will improve substantially as diabetes will no longer be a health burden.
Summary
This presentation has demonstrated how an outreach intervention can be used to address the diabetes problem affecting Country Walk community through modification of behavior.
The presentation has also proposed the interview method as an effective evaluation tool in assessing the success of the outreach intervention.
The roles of the community public health nurse have been well documented, as well as the importance of including lay heath workers (LHWs) and famous personalities in an outreach intervention targeting Hispanic adolescents.
A primary prevention strategy is important when using the outreach intervention as it aims to not only promote healthy behaviors (e.g., by demonstrating the importance of consuming fruits and vegetables, reducing the intake of fatty foods, and engaging in routine physical exercises), but also to protect against threats to health.
Important personalities have been included in the outreach intervention due to their appeal to the young people, while lay health workers have been included due to their knowledge in health issues and capacity to develop social networks and trust within the community.
It has also been demonstrated that age-specific and culturally-appropriate health education materials (e.g., posters and brochures) can be used to strengthen the outreach intervention by creating awareness on the modifiable risk factors associated with diabetes.
A number of studies have found the outreach intervention to be an effective approach that can be effectively used to trigger behavior modification among at-risk populations (e.g., Hispanic adolescents who are at risk of developing diabetes due to poor dietary habits and lack of physical exercises).
It is important to consider cultural perceptions of the targeted population if the outreach intervention is to succeed.
Based on this presentation, it can be concluded that the outreach intervention can be used to assist the targeted population in Country Walk (Hispanic adolescents) to modify their behavior and hence succeed in addressing the major risk factors associated with diabetes.
References
About Country Walk. (2016). Web.
Butler, K.M., Rayens, M.K., Adkins, S., Record, R., Langley, R., Derifield, S.,…Hahn, E.J. (2013). Culturally-specific smoking outreach in a rural community. Public Health Nursing, 31(1), 44-54.
Hatcher, E., & Whitmore, R. (2007). Hispanic adults’ beliefs about type 2 diabetes: Clinical implications. Journal of the American Academy of Nurse Practitioners, 19(10), 536-545.
Nguyen, B.H., Stewart, S.L., Nguyen, T.T., Bui-Tong, V., & McPhee, S.J. (2015). Effectiveness of lay health worker outreach in reducing disparities in colorectal cancer screening in Vietnamese Americans. American Journal of Public Health, 105(10), 2083-2089.
Public heath interventions: Applications for public health nursing practice. (2001). Web.
Tembreull, C.L., & Schaffer, M.A. (2005). The intervention of outreach: Best practices. Public Health Nursing, 22(4), 347-353.
Turpin, M.J., Asano, M., & Finlayson, M. (2015). Combining qualitative and quantitative data collection and analysis methods in understanding multiple sclerosis fatigue management. International Journal of Qualitative Methods, 14(2), 53-68.
In their 2019 article, Patricia Keresztes and Annette Peacock-Johnson review the pharmacologic treatment of Type 2 Diabetes (T2D) and provide instructions for healthcare professionals, particularly nurses, on their use in treating patients. The authors first emphasize that T2D is one of the most widespread diseases in the United States and the seventh leading cause of death (Keresztes & Peacock-Johnson, 2019). Keresztes & Peacock-Johnson (2019) argue that while lifestyle management remains one of the primary ways of T2D treatment, the pharmacologic method of therapy is another primary treatment method. Hence, nurses should familiarize themselves with the primary drugs used in T2D treatment, including special considerations, adverse effects, and mechanisms of action. Thus, the authors provide specific instructions on how nurses inject these drugs and when patients should take them.
Findings
The article reviews the nine groups of drugs used to treat T2D. With metformin as the primary type, although associated with B12 deficiency, Biguanides are one of the most effective drugs. Second-generation sulfonylureas, including glimepiride, glipizide, and glyburide, are the oldest and least expensive drugs after metformin (Keresztes & Peacock-Johnson, 2019). They are usually prescribed during the early stages of T2D (Keresztes & Peacock-Johnson, 2019). These medicines cause a higher risk of hypoglycemia, cardiovascular mortality, weight gain, skin rashes, and other adverse effects.
The third group is meglitinides which include nateglinide and repaglinide. Although they are less effective than sulfonylureas, they present a lower risk of hypoglycemia (Keresztes & Peacock-Johnson, 2019). Thiazolidinediones (glitazones) include pioglitazone and rosiglitazone and also present a lower risk of hypoglycemia (Keresztes & Peacock-Johnson, 2019). They entail several adverse effects, such as a bone fracture in women, weight gain, edema, and increased risk of pregnancy. The other groups of drugs include:
Alpha-glucosidase inhibitors.
Dipeptidyl peptidase inhibitors.
Glucagon-like peptide one receptor agonists.
Sodium-glucose cotransporter two inhibitors (canagliflozin, ertugliflozin).
Human amylin analog (pramlintide).
Each of these groups contains specific instructions on the injection, special considerations, and adverse effects. The authors also mention the importance of combination therapies and recommend that nurses be informed about them (Keresztes & Peacock-Johnson, 2019). As such, the authors present a concise and comprehensive summary of the different drugs legalized by the FDA and provide valuable instructions that nurses should consider while treating T2D patients.
Education of the local community members is one of the most efficacious ways of engaging licensed nursing students in the clinical process and indirect care experiences. Interaction with possible patients provides additional practice in communication, teaches novice nurses to be attentive and compassionate, and broadens their horizons. The present essay describes the experience of teaching people how to prevent diabetes and identifies its strong sides and areas for improvement.
Summary of Teaching Plan
This teaching targets members of the Punjabis Sikh society who are at risk of developing diabetes. To keep the audience interested and not overload it with information, the lecture lasted 35 minutes with a short break. One of the most critical components of the teaching was a test on diabetes results of which were announced after the class. The group consisted of 5 adults because this optimal size guarantees that the educator will pay enough attention to every participant and answer all the questions in detail.
The primary objective of the seminar is to reduce the annual number of diabetes cases and familiarize the audience with the very first signs of this disease. Therefore, at the first stage of the teaching, it is planned to introduce the effects of diabetes, including heart attack, stroke, cataract, and severe problems with nerves and feet. At the second stage, the nurse proceeds to explain the key symptoms of diabetes that under no circumstances could be ignored and require a prompt visit of a doctor. At this point, the goal of a nurse is to persuade the audience to be more vigilant about their health and do not ignore the discomfort. Afterward, the educator talks about such preventive measures as regular check-ups, a healthy diet, an active lifestyle, and body mass index normalization. Finally, the nurse familiarizes the members of the educational group with the straightforward algorithm of actions for the cases when a patient realizes that he or she has symptoms of diabetes. Apart from the oral presentation, the nurse distributes booklets with information on the topic, a list of preventive measures, and an action plan for those who found acute symptoms of type 2 diabetes.
Epidemiological Rationale for Topic
Type 2 diabetes mellitus is one of the most widespread diseases in the world. According to the report of the World Health Organization (2021), before the pandemic of COVID-19, diabetes was “the ninth leading cause of death” that takes 1.5 million lives per annum (para. 1). What is more, the current situation with diabetes is described by numerous scholars as pandemic (Toniolo et al., 2019; Selvin & Juraschek, 2020; Muniyappa & Gubbi, 2020). Currently, approximately 450 million people in the world are diagnosed with this disease, and by 2045 this number will be more than 600 million people (Toniolo et al., 2019). At this point, it should be mentioned that diabetes has significant implications for the ongoing pandemic of COVID-19. More precisely, several scholars have proven that diabetes complicates the course of coronavirus disease and increases the probability of a fatal outcome (Selvin & Juraschek, 2020; Muniyappa & Gubbi, 2020). The presented evidence suggests that diabetes is an acute problem that requires immediate action. Education of people at risk of developing this disease is one of the most effective measures that could be undertaken to tackle the described problem.
The target audience of the teaching is the adult population of Punjabis Sikhs because, in this community, the situation with diabetes is also adverse. The study of Gonzalez and Chauhan (2019) reveals that every fifth Punjabis Sikh older than 35 years develops type 2 diabetes mellitus. The reasons for such a high frequency of diabetes cases in this population lie in its genetic factors, cultural norms, and tradition to eat a lot of food that contains sugar (Sidhu et al., 2020). The situation is exacerbated by the fact that not all Punjabis Sikhs who live in the US could consult a doctor. That is because of the language barrier and the lack of awareness of the symptoms, causes, and consequences of type 2 diabetes. This way, the assistance of licensed nursing students in spreading information on diabetes among the adult members of the Punjabis Sikh community and educating Punjabis Sikhs is immensely precious.
Evaluation of Teaching Experience
Even though it is impossible to estimate the effectiveness of the teaching in the long-term perspective at the present moment, it still has already brought some positive effects. More precisely, out of five adults who attended the lecture, three were diagnosed with the early stage of diabetes, and two are at high risk of developing this disease in the nearest future. Hence, the lecture’s major achievement is that these people realized that they require immediate treatment, should take their health seriously, change their eating behavior, and increase rates of daily activity.
Overall, the experience of teaching could be regarded as successful. The most challenging aspect was to persuade at least five community members to attend the short class. The reasons for this are their past negative experience with medicine and the absence of understanding why prophylactic of any disease is crucial. Undoubtedly, when more than half of the participants were tested positive for diabetes, they were grateful for coming to the lecture. Nonetheless, prior to it, it took a considerable amount of time to explain to them how important it is to set aside a couple of hours for this activity. Fortunately, the presenter has managed to grab the attention of the audience from the very first minutes of the presentation and maintain their attention for the following hour. The primary drivers of this training’s success are the friendliness and communicativeness of the presenter.
As for the nurse who presented this short course, the critical inference is that it is crucial to put yourself in the patient’s shoes to increase the quality of the medical service. A nurse should be aware of a patient’s background, his or her culture, traditions, and worldview to establish trusting relations and guarantee that a patient will follow the treatment plan. Another inference from this teaching experience is that nurses help is not limited by the walls of a clinical facility. Instead, nurses can target people who hesitate to come to hospitals and generally cannot see a doctor due to a language barrier, as it is in the case of the Punjabis Sikh community members.
Community Response to Teaching
After the first lecture, it is still too early to discuss the response of the entire Punjabis Sikh society to the provided teaching. However, the positive sign is that the five group members who attended the first consolation on the prevention of diabetes mellitus noted that they feel like recommending it to their friends, colleagues, and relatives. Furthermore, a few days after the lecture, two targeted community members contacted the presenter and asked to include them in the list of participants for the following class. Even though it was not initially planned to conduct several seminars on the same topic, the received request under no circumstances could be ignored.
As it has already been mentioned above, three out of five participants were diagnosed with type 2 diabetes within the framework of the teaching. The fact that during the following four days, all of them visited the local hospital and were assigned a treatment plan is an outstanding achievement of this short class. These adults actions mean that they took the information provided during the presentation seriously and that they were persuaded of the necessity to treat this disease. The author hopes that such educative classes will be attended by far more than five representatives of the community in the future.
Areas of Strengths
The first strong side to be mentioned is the persuasiveness of the lecturer and the clarity of the distributed booklets and the presentation. The primary purpose of this brief lecture was to explain a complex ailment with simple words for people who have knowledge in the field of medicine and healthcare. The laconism of the slides and handouts assisted in communicating the very basic and the most crucial ideas to the audience. Another area of strength is the performance and communication skills of the presenter. Constant interaction with the audience kept them deeply involved in the lecture and greatly assisted in persuading them to take a diabetes test, visit a hospital, and change their lifestyle.
Still, the primary advantage of the teaching is that the participants indeed have decided to make an appointment with the doctor and took their health problem seriously. The possibility to test the blood for diabetes at the end of the lecture was an action that increased the effectiveness of the entire session. If the teaching consisted of the presentation exclusively, the probability that the participants would attend a hospital to check the blood for diabetes was low. People commonly have a lot of other duties and urgent matters, so it was necessary to combine the educative presentation with the blood testing.
Areas of Improvement
Although the teaching could be regarded as effective, there is room for improvement. The Punjabis Sikh community in the USA consists of more than 200,000 members, and five adults who attended the lecture are a drop in the ocean. This way, it is essential to attract more people to participate in such events and take more serious actions on promoting such sessions in the local Punjabis Sikh community. The second issue is that the presenter gave each participant three booklets during this short class: brochures with the list of symptoms, brochures with the list of preventive measures, and action plan brochures. The problem is not in the quality of the handouts but in their number. In the epoch of digital technologies, it could be more effective to provide the audience with the link to download one pdf file with the same information as in the three paper booklets. This solution not only guarantees that participants will not lose the papers, but it is also ecology-friendly.
References
Gonzalez, M., & Chauhan, H. (2019). Health Needs Assessment of the Punjabi Sikh Community in the San Joaquin Valley. APHA’s 2019 Annual Meeting and Expo (Nov. 2-Nov. 6). American Public Health Association.
Toniolo, A., Cassani, G., Puggioni, A., Rossi, A., Colombo, A., Onodera, T., & Ferrannini, E. (2019). The diabetes pandemic and associated infections: Suggestions for clinical microbiology. Reviews in Medical Microbiology, 30(1), 1-17. Web.
