HCA 620 Capstone Project Proposal

Sample Answer

Background

The main problem that this capstone project seeks to investigate is the prevalence of diabetes among individuals from African American ethnicity. Diabetes mellitus is an endocrine disorder that is characterized by the inefficient regulation of blood sugar levels. It is estimates that the prevalence of diabetes in America in 2018 was 34.2 million people. This rate represented 10.5% of the whole population in the state.

The rate of diabetes type 2 among individuals from African American background is higher when compared to those of other ethnicities. Accordingly, the rate of diabetes in African Americans is estimated to be 18.7% in adults aged above 20 years when compared to 7.1% in the non-Hispanic white Americans.

There is also the evidence that the risk of the disease is 77% higher in African Americans when compared to non-Hispanic white Americans (Cunningham et al., 2018). Despite the high rate of disease prevalence in this population, minimal efforts have been embraced to address it.

Clinical Problem Statement

African American population is disproportionately impacted by diabetes due to various factors such as low level of accessibility to health care, environmental, genetic, physiological, socioeconomic, and behavioral. Besides, African Americans are 2.6 times likely to experience end-stage renal disease due to diabetes (American Diabetes Association, 2020).

Diabetes can lead to possible brain and heart complications such as blood pressure and stroke, potential complications relating to unhealthy weight such as obesity or overweight, potential vision complications such as blindness, kidney complications such as kidney diseases, and complications to the nerves, legs, and feet such as risk of amputation.

Diabetes mellitus type 2 is also associated dire economic burden to the patient and their families due to factors such as cost of health care, loss of productivity, loss of income, and high death rates. Therefore, it is vital to address the issue of diabetes mellitus in nursing practice to help in increasing the knowledge on this population on the best care.

Purpose of the Change Proposal in Patient Care Provision

Diabetes mellitus type 2 has been shown to disproportionately affect African American population. Therefore, this paper proposes the implementation of nurse led diabetes self-management education among the African Americans visiting the clinic to help them change their behaviors and proficiently manage type 2 diabetes mellitus (Hailu, Hjortdahl& Moen, 2018).

The intervention focuses on ensuring that the nurses lead the implementation of the behavioral and lifestyle interventions that are needed for the effective management of diabetes such as compliance to the appropriate diet, understanding preventive measures, and integration of self-management strategies in diabetes mellitus type 2 among African American population.

The intervention will also promote evidence-based practice in nursing by ensuring that the best available studies on clinical interventions are utilized to ensure equality in the care of patients with diabetes mellitus type 2. Eventually, the patients will be empowered to make informed lifestyle changes and choices to enhance diabetes mellitus type 2 outcomes.

PICOT Question

The following PICOT question will guide the proposed evidence-based practice project.

In African American patients aged between 18 and 40 years, does the use of nurse-led education on diabetes self-management result in better treatment outcomes when compared to the usual care in a period of six months?

Literature Search Strategy Employed

Literature search was majorly done online on various nursing databases including Google Scholar, CINAHL, PubMed, EBSCO, MEDLINE, Cochrane Library, Proquest Central, and Science Direct. The rationale for choosing these databases was their ability and flexibility in sophisticated searches and filtering. The databases also have outstanding nursing and journals related to health care. During the search process, certain specific terms used included nurse-led education, diabetes self-management, and African Americans population.

Regarding how the search process was conducted, at the beginning of search, only journals touching on nursing were emphasized since the present project is on nursing. However, other medical related journals were later utilized to help in getting more background information. The primary consideration was on the studies that highlighted educational interventions for diabetes, especially nurse-led educational programs.

The project was also strict on utilization of recent studies published from the year 2015 to 2020 due to their ability to give current information and statistics as opposed to the older studies, which mostly contain obsolete information. After completing the inclusion criteria, duplicated studies were eliminated alongside the ones that never met the inclusion criteria.

Evaluation of the Literature

The literature evaluation table was used to conduct literature evaluation for the project. The table specified areas to be evaluated on various studies that were used. The areas that were required included the author of the article, name of the peer reviewed journal, permalink or working link to access article, article title and year published, research questions or hypothesis, purpose of the study, study design, setting or sample, methodology entailing of intervention or instruments, analysis, key findings, recommendations, and explanation of how the article supports EBP/capstone project. Ultimately, all the articles that were used in this project were evaluated as per these requirements in the literature evaluation table.

Theoretical Model to be Utilized

The trans-theoretical model of behavioral change will be utilized in the proposed evidence-based practice proposal. The trans-theoretical model of behavioral change provides insights into the way in which people make decisions related to changing their behaviors. According to this theory, behavioral change occurs in a series of steps. The change must occur in steps to ensure is sustainability in use by the target populations.

The steps of the theory include pre-contemplation, contemplation, preparation, action, maintenance, and termination. Pre-contemplation is the first stage in the theory where the participants are not aware of the need to engage in self-management behaviors for diabetes. They do not understand the problems associated with their lack of engagement in self-management activities for diabetes

Contemplation stage is the second phase where the participants explore the need for making behavioral change for effective management of diabetes. They understand the negative effect that lack of self-management has on their health. As a result, they are willing to engage in self-management of diabetes. The third stage is preparation where the African American patients are ready to embrace the behavioral and lifestyle interventions utilized in the self-management program.

The fourth step is action stage where the participants are highly motivated to engage in additional behaviors that will enhance the self-management of diabetes. The maintenance stage is characterized by the participants identifying ways in which the self-management behaviors can be sustained for long-term use in the management of diabetes.

Lastly, termination stage is characterized by complete change in lifestyle and behaviors of the participants since they are not willing to engage in activities that does not support self-management of diabetes.

Proposed Implementation Plan with Outcome Measures

The implementation of the proposed evidence-based practice project will occur in steps. The first one will be the identification of sample group from the target population, which is African American population with diabetes mellitus type 2 from the diabetic clinic. They participants will then be informed about the intervention and consent obtained from them. Consequently, needs assessment is another step done to identify vital issues and problems the target population tends to encounter in creating effective diabetes educational program.

The next step is creating precise objective of the project, which is the change intervention of developing a nurse-led diabetes education program. The subsequent step is choose intervention context which entail different activities including formulation of a precise hypothetical background for the intervention, performing systematic reviews and need assessments to provide guidelines on change development and finally, relying on professional advice to produce ideal change intervention.

The last step is organization of the change context and assessing the intervention. If the change intervention is deemed appropriate, it is applied in the change project. The patients will be followed up for six months. The outcome measures that will be of focus will include HbA1c levels, blood pressure, weight, and incidences of complications of diabetes. Baseline data on these measures will be obtained for comparative purposes.

How Evidence-Based Practice was used

Evidence-based practice (EBP) was used in the development of the project in several ways. One of them was the use of best available clinical and research evidence to determine the effectiveness of the intervention. Patient values and clinical expertise were also used in determining the most effective interventions that can be used to improve outcome treatment in diabetic patients.

EBP was also utilized to inform the educational strategies and interventions and determine the suitability of educational program. Moreover, enhancement of learning and educational outcomes of the patients significantly depends on utilization of best reliable evidence.

Plan for Evaluating the Proposed Nursing Intervention

The intervention will be evaluated based on the obtained outcomes. Baseline data will be compared to those obtained by the end of the intervention period. An improvement in measures such as blood pressure, weight, HbA1c levels, and complications of diabetes will be considered indicators for program effectiveness.

The percentage of participant dropout will also be used as an indicator for the effectiveness of the intervention. Various tools such as patient follow-ups, questionnaires, and interviews will be used for evaluation to establish the success of the nurse-led educational program.

Potential Barriers to Implementation

One of the potential barriers to implementation of this project is the disinclination of the participants to participate in the change process. The issue will be addressed by educating participants on the health benefits of the program to influence their decisions. The second barrier is dropout of the participants.

This issue will be addressed by actively following up the participants to identify their challenges and ways of addressing them. The last potential barrier is lack of time for the nurses. Nurses might be overwhelmed by their work-related demands to implement the project. The issue will be addressed by relieving the nurse educators for the project off their duties during the days when the project will be implemented.

References

• American Diabetes Association. (2020). Main.diabetes.org. Retrieved 28thAugust 2020, from http //main.diabetes.org/dorg/PDFs/Advocacy/fact-sheet-advocacy-african-american.pdf
• Cunningham, A. T., Crittendon, D. R., White, N., Mills, G. D., Diaz, V., &LaNoue, M. D. (2018).The effect of diabetes self-management education on HbA1c and quality of life in African-Americans a systematic review and meta-analysis. BMC health services research, 18(1), 367
• Hailu, F. B., Hjortdahl, P., & Moen, A. (2018). Nurse-led diabetes self-management education improves clinical parameters in Ethiopia. Frontiers in public health, 6, 302.