10 Strategic Points

Sample Answer

Ten Strategic Points

The 10 Strategic Points

Title of Project

1. Title of Project

• Application of weekly telehealth calls in the management of diabetes type II
  
• Background
  
• Theoretical Foundation
  
• Literature Synthesis
  
• Practice Change Recommendation
  

2. Background to Chosen Evidence-Based Intervention

List the primary points for six sections.

Background of the practice problem/gap at the project site
Diabetes is one of the chronic illnesses which impacts individuals’ lives negatively. According to Skinner et al. (2020), this chronic illness leads to other life-threatening diseases like heart conditions.

Besides, diabetes is so prevalent that millions of people are living with it. In the past and present times, diabetes various interventions have been applied in efforts to manage and control the condition. However, the condition remains to be among the most chronic diseases.

One of the major focuses of diabetes management initiatives is improved or better glycemic control. However, in most cases, people living with the condition fail to attain the targeted HbA1c levels, largely because of risky lifestyle behaviors.

Significance of the practice problem/gap at the project site

Due to the various adverse impacts resulting from diabetes, the condition has attracted the attention of various stakeholders such as researchers, doctors, nurses, and other healthcare professionals and associates. In recent years, there have been notable strides in managing the condition due to technological advances and advances in diagnostics and treatments (Haque et al., 2021).

However, millions of individuals annually get the disease while many others die due to the condition, with the prevalence rates rising as years pass by. Nonetheless, the adverse impact due to diabetes can be reduced by applying various nursing interventions such as tapping the technological potentials such as telehealth interventions like weekly calls to guide patients on management practices and lifestyle modifications for better diabetes outcomes such as improved glycemic control.

Theoretical Foundations (choose one nursing theory and one evidence-based change model to be the foundation for the project) The implementation of nursing interventions needs to be theory-guided as theories offer important guidelines. Therefore, this project will use Dorothea Orem’s self-care theory.

The theory is mainly about an individual’s ability to perform self-care as “the practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being (Butts & Rich, 2018). Dorothea’s theory has three interconnected sub-theories; the theory of self-care, the self-care deficit theory, and the theory of nursing systems.

Annotated bibliography

Presley, C., Agne, A., Shelton, T., Oster, R., & Cherrington, A. (2020). Mobile-enhanced peer support for African Americans with type 2 diabetes a randomized controlled trial. Journal of General Internal Medicine, 35(10), 2889-2896. https //doi.org/10.1007/s11606-020-06011-w.

This study by Presley et al. (2020) was conducted with the aim of comparing the impact of a community-based self-management education integrated with phone calls and a similar education without phone calls among individuals with poorly controlled diabetes.

In a randomized controlled trial, the researchers recruited a total of one hundred and twenty patients who were randomized into either the control or intervention group, with ninety-seven of the participants completing the study. While the individuals in the intervention group received a community-based self-management education integrated with weekly phone calls for twelve weeks as support, the control group received only the community-based self-management education.

The analysis of the data indicated that individuals in both groups had a statistically significant reduction in the levels of HbA1c. Nonetheless, the observed difference between the intervention and control groups was not statistically significant.

Vaughan, E. M., Hyman, D. J., Naik, A. D., Samson, S. L., Razjouyan, J., & Foreyt, J. P. (2021). A telehealth-supported, Integrated care with CHWs, and ME dication-access (TIME) Program for Diabetes Improves HbA1c A randomized clinical trial. Journal of General Internal Medicine, 36(2), 455-463. https //doi.org/10.1007/s11606-020-06017-4.

Vaughan et al. (2021) also conducted a study with the aim of comparing the HbA1c levels outcomes for patients who were offered telehealth-supported integrated care with those who got usual diabetes. In a randomized controlled trial, the researchers recruited eighty-nine research subjects to take part in the study, with forty-five randomized into the control group while forty-four were recruited into the intervention group.

The intervention group received specialized care whether they were contacted once a week for six months and twice a month for the next six months by trained community health workers through texting or through calls. During the calls, the health professionals discussed with the patients various aspects of diabetes care, such as glycemic control and medication adherence, while also answering any concerns or questions as raised by the patients.

The individuals in the control group received only usual care without the telehealth intervention. The results obtained from the data analysis indicated that the individuals in the intervention group showed a more statistically significant reduction in the HbA1c levels in comparison to those in the control group (p-value of 0.002). Therefore, the application of telehealth in supporting the management of diabetes led to better glycemic control among patients with diabetes.

Peasah, S. K., Granitz, K., Vu, M., & Jacob, B. (2020). Effectiveness of a student pharmacist-led telephone follow-up intervention to improve hemoglobin A1C in diabetic patients. Journal of Pharmacy Practice, 33(6), 832-837. https //doi.org/10.1177%2F0897190019857409

This study was undertaken with the aim of examining the impact of telephone call follow-up in improving the HbA1c levels among patients living with diabetes. The researchers also used a randomized controlled pilot study with a total of 78 patients who were randomized equally into the control and intervention groups.

Participants in the control groups were only offered the usual diabetes care while those in the intervention group got the usual care with weekly phone calls, which were to act as reminders on various aspects of medication adherence as part of diabetes management. From the analysis of the collected data, the results showed that the phone calls led to a substantial impact as the reduction in the HbA1c levels among the patients in the intervention group was statistically significant, with a p-value of 0.027 recorded.

The HbA1c levels among the patients in the control group were observed to increase, with a p-value of 0.013 recorded. Therefore, the use of telehealth calls led to improved glycemic control.

Sherifali, D., Brozic, A., Agema, P., Punthakee, Z., McInnes, N., O’Reilly, D., … & Gerstein, H. C. (2021). Effect of Diabetes Health Coaching on Glycemic Control and Quality of Life in Adults Living With Type 2 Diabetes A Community-Based, Randomized, Controlled Trial. Canadian Journal of Diabetes, 45(7), 594-600. https //doi.org/10.1016/j.jcjd.2020.11.012.

Sherifali et al. (2020) carried out a study with the aim of examining the effects of telephone call-based diabetes coaching on the levels of HbA1c levels among patients living with diabetes type 2. This was a randomized controlled trial with a total of three hundred and sixty-five patients forming the study participants. While 177 were randomized into the control group, the remaining 188 were recruited into the intervention group.

The individuals in the intervention group were offered a diabetes education integrated with weekly phone call follow-ups for six months, followed by monthly phone call follow-ups in the next six months. During the calls, the patients were encouraged and motivated to adhere to the prescribed lifestyle habits and answer any questions or concerns on diabetes management.

Upon the analysis of the data, the researchers noted that the individuals in the intervention group had a more significant reduction in the HbA1c levels as compared to those in the control group, as a p-value of less than 0.01 was recorded. Therefore, the integration of phone calls in diabetes management led to improved glycemic control.

Ravari, A., Sheikhoshaqi, A., Mirzaei, T., Raeisi, M., Hassanshahi, E., & Kamiab, Z. (2021). Effect of telenursing on blood glucose control among the elderly with diabetes A Randomized Controlled Trial. Evidence-Based Care, 11(2), 54-63. https //dx.doi.org/10.22038/ebcj.2021.58874.2531

This study was accomplished by Ravari et al. (2021) with the aim of exploring the efficacy of telenursing on glycemic control among patients living with diabetes with HbA1c levels the major focus. In a randomized controlled trial, the researchers recruited a total of eighty patients who were randomized into either the intervention or control group.

The intervention group received normal diabetes care with phone call follow-ups for up to three months. Two weekly phone calls were made in the first month. In addition, a weekly call was made in the second and third months. During the phone calls, issues connected to diabetes management, including exercise, diet, and medication administration, were discussed with the patients.

The control group did not receive any phone call follow-ups. The analysis of the collected data showed that the reduction of HbA1c levels was more significant in the intervention group as compared to the control group, with a p-value less than 0.001 recorded.

Practice Change Recommendation Validation of the Chosen Evidence-Based Intervention

At the facility, the use of diabetes standard care has been preferred. However, the results are not impressive, which calls for more interventions. As such, the use of weekly telehealth calls is proposed as an intervention to be translated to help patients in improving their HbA1c.

Summary of the findings written in this section.

From the annotated articles, the use of phone call follow-ups in diabetes management led to improved diabetes management and care outcomes among patients living with diabetes. This was shown in the reduction of HbA1c levels, which was statistically significant upon the application of the telehealth interventions.

3. Problem Statement

Describe the variables/groups to project in one sentence.
It is not known if the implementation of the weekly telehealth calls would impact HbA1c levels among patients with diabetes type II. The telehealth calls are meant to reinforce diabetes management strategies so as to improve the patient’s glycemic control daily blood sugar monitor.

PICOT to Evidence-Based Question 4) PICOT Question Converts to Evidence Based Question

Among adult patients with type 2 diabetes in the outpatient clinic, will the implementation of weekly phone calls as translated from Sherifali et al. (2020), compared to current practice, reduce daily blood sugar monitor and HbgA1C within 12weeks?

Evidence-Based Question

Provide the templated statement.

To what degree will the implementation of weekly telehealth calls impact HbA1c levels and daily blood sugar monitor among adult patients with type two diabetes in the outpatient clinic in Arizona?

• Sample
• Setting
• Location

Inclusion and Exclusion Criteria 5) Sample, Setting, Location

Sample and Sample Size The targeted sample size is seventy patients living with diabetes. Potential bias is that the sample will be obtained from a single center which may lead to bias. This may be mitigated by getting patients from diverse locations to solve the possible problem of lack of generalizability.

• Setting The setting for the study is an urban primary care hospital
  
• Location an Urban area in Arizona
  
• Inclusion Criteria
  
• Patients must be at least 18 years and have diabetes
  
• Exclusion Criteria
  

Individuals with unstable mental states and those who fail to sign consent forms will be excluded

Define Variables 6) Define Variables

• Independent Variable (Intervention) weekly telehealth calls
  
• Dependent Variable (Measurable patient outcome) HbA1c levels and daily blood sugar monitor
  

Project Design 7) Project Design

This project will use a quality improvement approach. You must be able to explain and cite the difference between research and quality improvement (one paragraph each).

• Quality Improvement a quality improvement refers to an initiative that has been designed with the aim of bringing an immediate improvement in patient care
  
• Research Research refers to an act of testing or replicating new ideas other than the current knowledge and the standard practice.
  
• Summarize In summary, this project entails the use of weekly telehealth calls to improve diabetes outcomes such as HbA1c among patients living with diabetes.
  

Purpose Statement 8) Purpose Statement

Provide the templated statement.

The purpose of this quality improvement project is to determine if the implementation of weekly telehealth calls would impact HbA1c levels and daily blood sugar monitor among adult patients with diabetes. This project will be piloted over an eight-week period in an urban primary care clinic in Arizona.

Data Collection Approach 9) Data Collection Approach

• The patient’s demographic data will be obtained and used during the analysis. The overall knowledge will be determined using the Revised Brief Diabetes Knowledge Test instrument.
  
• Electronic health records will be used in collecting patients’ baseline data, such as the HbA1c levels.
  
• The reliability of the Revised Brief Diabetes Knowledge Test instrument is (α ≥ 0.70) while the validity ranges from 0.83 to 0.96
  
• Describe the step-by-step process you will use to collect the data, explain where the data will come from, and how you will protect the data and participants.
  

As earlier indicated, electronic health records will be key in getting the baseline data.
Upon implementing the intervention, the new HbA1c levels will be obtained, and a comparison drawn with the baseline values. The results will also be compared between the intervention and the control group. The patient data will be protected through restricted access, passwords, and encryption.

A range of ethical issues is likely to arise. As exclusion criteria, patients who refuse to offer informed consent will be excluded. Data confidentiality vs. data anonymity is also likely to arise.

It is key to comply with the Belmont principle. Therefore, as part of this plan, the project seeks to ensure that no patient is harmed. The patients will be encouraged to exercise freedom of choice and therefore choose to either participate in the project or not.

An unfair exclusion will also be eliminated to ensure that everyone has an equal chance of benefiting. Confidentially, the privacy and security of the patient data will also be a priority.

Data Analysis Approach 10) Data Analysis Approach

Data analysis is key in determining the impact of the intervention. Therefore SPSS will be employed in data analysis. Descriptive statistics will also be used, while pre-and post-analysis will be applied to determine the impact of the intervention.

Pearson’s correlation and paired t-test will be key, with the services of a statistician sought for analysis and interpretation. A most relevant study design will help in solving potential data bias, for example, improved glycemic control due to other patients’ self-initiated diabetes management unrelated to the proposed intervention.

References

• Butts, J. B., & Rich, K. L. (2018). Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers.
  Haque, W. Z., Demidowich, A. P., Sidhaye, A., Golden, S. H., & Zilbermint, M. (2021). The Financial Impact of an Inpatient Diabetes Management Service. Current Diabetes Reports, 21(2), 1-9. https //doi.org/10.1007/s11892-020-01374-0.
  
• Peasah, S. K., Granitz, K., Vu, M., & Jacob, B. (2020). Effectiveness of a student pharmacist–led telephone follow-up intervention to improve hemoglobin A1C in diabetic patients. Journal of Pharmacy Practice, 33(6), 832-837. https //doi.org/10.1177%2F0897190019857409
  
• Presley, C., Agne, A., Shelton, T., Oster, R., & Cherrington, A. (2020). Mobile-enhanced peer support for African Americans with type 2 diabetes a randomized controlled trial. Journal of General Internal Medicine, 35(10), 2889-2896. https //doi.org/10.1007/s11606-020-06011-w.
  
• Ravari, A., Sheikhoshaqi, A., Mirzaei, T., Raeisi, M., Hassanshahi, E., & Kamiab, Z. (2021). Effect of tele-nursing on blood glucose control among the elderly with diabetes A Randomized Controlled Trial. Evidence Based Care, 11(2), 54-63. https //dx.doi.org/10.22038/ebcj.2021.58874.2531
  
• Sherifali, D., Brozic, A., Agema, P., Punthakee, Z., McInnes, N., O’Reilly, D., … & Gerstein, H. C. (2021). Effect of Diabetes Health Coaching on Glycemic Control and Quality of Life in Adults Living With Type 2 Diabetes A Community-Based, Randomized, Controlled Trial. Canadian Journal of Diabetes, 45(7), 594-600. https //doi.org/10.1016/j.jcjd.2020.11.012.
  
• Skinner, T. C., Joensen, L., & Parkin, T. (2020). Twenty‐five years of diabetes distress research. Diabetic Medicine, 37(3), 393-400. https //doi.org/10.1111/dme.14157
  
• Vaughan, E. M., Hyman, D. J., Naik, A. D., Samson, S. L., Razjouyan, J., & Foreyt, J. P. (2021). A telehealth-supported, I ntegrated care with CHWs, and ME dication-access (TIME) Program for Diabetes Improves HbA1c A randomized clinical trial. Journal of General Internal Medicine, 36(2), 455-463. https //doi.org/10.1007/s11606-020-06017-4.