Change Strategy and Implementation
MSN FPX 6021 Change Strategy and Implementation KP
The Centers for Disease Control and Prevention (CDC) was granted by Congress in 2010 to create and start the National Diabetes Prevention Program (National DPP). National DPP is a public and private program that offers evidence-based, cost-effective involvements in societies across the United States to avoid type 2 diabetes. This program creates partnerships between community-based administrations, private insurers, health care professionals, companies, healthcare institutions and management agencies and is inspiring these entities to work collaboratively to decrease the occurrence of prediabetes and type 2 diabetes (Butler & Kirk, 2020). A key factor of the Nationwide DPP is evidence-based diabetes prevention programs (DPPs)– which educates the individuals to make long-lasting lifestyle changes, like eating better, adding physical activity into their daily practices, and bettering their coping skills to avoid or delay the beginning of type 2 diabetes. To safeguard high quality, CDC only identifies DPPs that meet precise and detailed standards- and are proven to accomplish the goals. These standards include carrying out the reviewed curriculum created by the CDC and DPP’s, facilitation by a healthcare professional and its team, and submitting the statistics annually to show that the program is having an impact.
Diabetes self-management education and support (DSMES) services enables patients to access knowledge, learn skills, and provide decision making to optimize diabetes self-care and integrate the needs, life experiences, and goals of the individual with diabetes. The general purposes of DSMES are to support informed decision-making, problem-solving, self-care behavior, and dynamic collaboration with the healthcare professional team to better the individuals’ clinical results, better health status, and welfare in a cost-effective manner (Butler & Kirk, 2020).
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Diabetes and Hyperlipidemia
Individuals with type 2 diabetes, coronary artery disease is the most common cause of death (Reamy, 2018). It has been commonly seen that lipid abnormalities are linked with diabetes, particularly in those with type diabetes mellitus type 2. The most common lipid irregularities in these individuals include hyper-triglyceridemic and a low high-density lipoprotein (HDL) cholesterol level. While lipid abnormalities characteristically get better with better glycemic control and a decreased A1C level, regularization does not usually happen. This is due to there a strong connection between all forms of vascular illness in patients with diabetes type 2 and hyperlipidemia, it is imperative to have the individual get frequent blood tests and treat the elevated lipid levels.
MSN FPX 6021 Change Strategy and Implementation KP
According to Reamy in 2018, yearly screenings for elevated lipid in patients with diabetes is strongly suggested. Such screening should include measuring the blood of total cholesterol level, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride levels. An adequate LDL level is lower than 1129 mg per dL (3.41 mmol per L); triglycerides should be lower than 199 mg per dL (2.31 mmol per L). Individuals with a clinically diagnosis of cardiovascular vascular disease, LDL levels should be less than 100 mg per dL (2.59 mmol per L), and triglycerides should be less than 149 mg per dL (1.69 mmol per L). Whether these lab values should be a goal for all individuals with type 2 diabetes, no matter whether they developed vascular disease, has been argued. An HDL level of greater than 45 mg per dL is recommended (1.20 mmol per L).
The management of hyperlipidemia should begin with a plan to improve glycemic control, lowering the A1C level, and decreasing their weight to better their Body Mass Index
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(BMI). Exercising often should be incorporated into the weight-loss regimen, evidence has shown that if the individual does both, weight loss improves, and weight upkeep is enhanced. Weight loss will result in a reduction in triglyceride levels and an increase “the good fat” in HDL levels (Scheen, 2021). Prior to the exercise program being recommended, previous medical conditions that would upsurge the risks of exercise should be considered, including the presence of diabetic retinopathy, nerve and podiatry complications. It is sensible to recommend an exercise tolerance test to rule out any heart problems, predominantly in patients older than 40 years of age.
Diabetes and Heart Disease
Heart disease and long-term diabetes often go hand in hand. It is important for the individual having these problems learn how to protect their heart with minor but effective lifestyle alterations that can also help control and manage diabetes. Heart disease is very common but very serious. It’s the leading cause of death for both women and in the United States (Tatum, 2017). If a person diabetes, they are twice as likely to have cardiovascular disease or a cerebral vascular accident (CVA) than someone who does not have diabetes—and at a younger age. The longer a person diabetes, the likelihood of them having heart disease increases drastically. The good news is that a person can lower the risk for heart disease and better their heart health by altering certain lifestyle behaviors. These changes will help manage the diabetics blood sugar and Hemoglobin A1C better too.
Change Strategies
At the Diabetes Educational Summit, scientific professionals in education specializing in diabetes highlighted the importance of using nursing theory to encourage future research and
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diabetic guidelines to better one’s health. When trying to implement change for a patient with a prolonged diagnosis of diabetes, one method that has shown to be effective is called the Transtheoretical Model (TTM). This model is highly effective due to its many applications and stages of readiness for change, especially for nursing and its continuing evolution of practice. This model has been studied and developed for nearly 4 decades (Tatum, 2017). TTM also emphasizes on both bettering a person’s enthusiasm in those not ready to change their behavior and improve self-manage circumstances- and providing a change of behavior for people who are motivated.
MSN FPX 6021 Change Strategy and Implementation KP
This TTM change strategy will utilize interprofessional considerations and ensure successful implementation for a diabetic patient because in a nutshell, the TTM assesses patient’s readiness to both fix their diabetic care gaps and education problems, behavioral trends- and act on new, more positive behaviors. This model occurs across a continuum of a six stage process, with staff knowing the patients mindset at the beginning have no desire to change and buy into any changes that are hard to break. If the TTM is correctly done, we can assume that the behaviors of the patients who needed to change will reach there desired health outcomes on a long term basis. Our Diabetic patients will need to change eating habits to manage blood sugar, patients with emphysema will need to quit smoking, and more. Patients may or may not take action, and the process of change can be a gradual one.
THE TRANSTHEORETICAL MODEL: HELPING DIABETIC PATIENTS
The Stages of Change
The stages of change most used across the TTM research areas comprise of: Precontemplation—not anticipating changing the behavior to achieve the goal.
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Example-Not modifying their diet or regularly exercising in the foreseeable future
Contemplation—showing intent to change the behavior to achieve the goal in the foreseeable future (inside 3 months), but not the immediate future (next 15 days);
Example- Having the individuals Hemoglobin A1c levels drop from 13 to 10
Preparation—showing behaviors and having intentions to change. The individuals’ goals and actions are in the near future and taking the necessary behavioral steps in the path to change.
Example- The individual gets a gym membership and is registered in the National Diabetes Prevention Program.
Action—A behavioral change has been made to achieve the goal. The level of the behavior has been completed within the past 3 months.
Example- The individual has hired a personal trainer and works out at the gym 5x a week. The patient has and has entirely changed his diet that is compiled of diabetic tips.
Maintenance—has been at the goal level of the behavior for 6 months or longer?
Example- The individuals Hemoglobin A1c level is now 9.0 and has followed a strict diabetic diet and exercise routine that has been maintained for over 6 months.
MSN FPX 6021 Change Strategy and Implementation KP
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Data Table
| Current Outcomes | Change Strategies | Expected Outcomes |
| Many individuals who have Diabetes Type 2 may not have all the essential resources to better their outcomes: a) From blood sugar meters, test strips, syringes, and storage bins, the cost of diabetes materials can add up. Self-monitoring of blood glucose with strips alone can cost up to 40% of all diabetic and insulin supply fees, with the price of products changing considerably between companies. b) Diabetes is a complicated disease process that requires self-management of blood sugar level and skin care (Butler& Kirk, 2020). – making healthy food choices, checking your blood glucose frequently, staying active, and taking medications. It is also important to talk frequently with their diabetic care team to resolve any issues, lower any risks for problems, and manage lifestyle changes. | To ensure that individuals obtain the diabetic care they need, certain actions are needed: a) The patient is registered into the National Diabetes Prevention program to decrease the occurrence of prediabetes and type 2 diabetes b) Diabetes care management and educational curricula personalized to the patient’s diabetic health. c) All necessary supplies are provided: Syringes, waste containers, insulin, and proper storage supplies. | Patients who have type 2 Diabetes will have all the essential recourses they need to properly manage their blood sugar levels and hemoglobin A1c levels. Their results will be better than ever: a) Faith-based organizations (FBOs), community-based organizations (CBOs), community healthcare workers (CHWs), and other community assemblies can take a dynamic role in helping individuals who are at risk for type 2 diabetes, patients with diabetes, along with their families build healthier lives and decrease their risk (Stanley,2018). b) Diabetes care management and teaching experts are found in accredited programs across the country at no cost to the patient. They work with the individual to develop strategies to stay healthy and give tools for ongoing provision to make that strategy a normal part of your life (Tatum, 2017). c) Diabetes self-management education and support (DSMES) services permit individuals to achieve their everyday and lifetime goals for living better with type 2 diabetes. |
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References
Butler, G., & Kirk, J. (2020). Diabetes mellitus. Endocrinology and Diabetes, 135-224. https://doi.org/10.1093/med/9780198786337.003.0005
Reamy, B. V. (2018). Practical approach to the patient with hyperlipidemia. Hyperlipidemia Management for Primary Care, 193-199. https://doi.org/10.1007/978-0-387-76606-5_9 Scheen, A. (2021). Exciting breakthroughs in the management of diabetes mellitus. Diabetes Epidemiology and Management, 1, 100005. https://doi.org/10.1016/j.deman.2021.100005 Stanley, T. (2018). Metabolic disorders with diabetes. AccessScience. Https://10.1036/1097- 8542.417400 Tatum, B. (2017). National standards for diabetes self-management education programs and american diabetes association review criteria. Diabetes Care, 21(Supplement_1), S95- S98. https://doi.org/10.2337/diacare.21.1.s95