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Change Strategy and Implementation

Alexandra Sanders

Capella University

NURS-FPX6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

Dr. Katie Hooven

November 2021

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Change Strategy and Implementation

An overwhelming 10.5 percent of the American population has been diagnosed with

diabetes (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.) Diabetes is a

chronic metabolic disease characterized by elevated blood glucose levels that can lead over time

to severe damage to the heart, blood vessels, eyes, kidneys, and nerves (World Health

Organization [WHO], 2021). When blood glucose levels run too high, diabetes occurs. There are

three main types of diabetes: type I, type II, and gestational. In type I, the body does not produce

insulin. People with type I are placed on insulin and a proper diet and exercise to live productive

lives. Type II diabetes is the most common form of diabetes. In type II, bodies do not use insulin

properly. A proper diet and exercise regimen helps treat type II along with insulin or oral

medication. Gestational diabetes occurs in women who are pregnant who have never had a

diagnosis of diabetes. It is treated much like type II (American Diabetic Association [ADA],

2021).

Diabetes is very underrated as a global health issue. It is considered the greatest epidemic

in human history, affects the highest number of people globally, and costs the most money in

treatment and research (Zimmet, 2017). Nearly 422 million people worldwide have diabetes, the

majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed

to diabetes each year (World Health Organization [WHO], 2021). Globally the target goal is to

stop the rise in diabetes and obesity by 2025. Several factors come into play to improve quality

of life and longevity when dealing with diabetes and patients with diabetes. Patients need to

understand what diabetes is and how it affects their bodies; they need support from family,

friends, and healthcare staff. One of the most critical factors in diabetes is understanding the

ramifications of being non-compliant with their diabetes.

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Kidney Disease and Diabetes

Chronic kidney disease (CKD) is a common diagnosis in patients with diabetes. CKD can

be a devastating diagnosis and lead to shorter life spans and poor quality of life (McFarlane et

al., 2018). Damage to the kidneys can lead to kidney failure and ultimately need for dialysis or

transplant. Ensuring that blood glucose levels are kept under control, eating a healthy diet, and

maintaining a healthy weight can help decrease the chances of a diabetic developing CKD (The

Cleveland Clinic, n.d.).

Depression and Diabetes

Being diagnosed with diabetes can lead to emotions of stress, grief, and frustration. These

emotions can trigger depression. In newly diagnosed patients, depression is commonly seen but

can also affect patients who have had diabetes a long time. Emotional issues can lead to poor

diet, lack of exercise, and higher blood glucose levels (The Cleveland Clinic, n.d.). Patients with

diabetes are more likely to suffer from depression than a patient without diabetes.

Change Strategies

When patients are diagnosed with diabetes, they must understand and make an effort to

learn more about diabetes and its diagnosis. Education is the foundation for the management and

care of diabetes and is an essential part of health planning. It involves the patient and their

family, diabetes care team, community, and decision-makers in the education process (Rashed et

al., 2016). Healthcare providers should enhance the quality of patient care by providing

multimedia diabetes health education (Huang et al., 2016). Teaching patients about a healthy

diet, exercise, taking medications, and reducing stress are some of the critical components to

controlling diabetes (Centers for Disease Control and Prevention [CDC], 2021). The Diabetes

Knowledge Questionnaire ( DKQ-24) is a tool used to test patients' knowledge of diabetes. In

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one, 50 patients took the DKQ-24, and they got sixty percent of the questions correct. The

majority of these participants had had prior diabetes education. The study showed that providing

adequate education is imperative to reduce the burden of this condition (Formosa & Muscat,

2016). For patients to understand diabetes, a multidisciplinary team is necessary. The team would

consist of a primary care physician, nurse educator, dietician, and patient family. If indicated, an

endocrinologist and podiatrist could be added to the team.

Diabetic foot care is one of the number one needs of a diabetic patient. Proper footwear

and proper care of the feet can decrease the chances of diabetic foot ulcers and potential loss of

limbs. A nurse and or podiatrist can teach about foot care. A dietician and diabetic education are

crucial members of the team. They help pave the way for proper nutrition and food selection and

teach how food affects blood glucose levels. Teaching how to check blood glucose levels and

how to take medication are essential roles of these clinicians. Having this multidisciplinary team

helps the primary care physician and the patient to manage diabetes better.

Ensuring patients have support from family and mutual trust for the healthcare team aids

in giving a positive outlook for the patient regarding the diabetes diagnosis and necessary

lifestyle changes. The support leads to compliance from the patient also. Noncompliance in

diabetes can lead to kidney disease, heart disease, loss of eyesight, and loss of limbs, to name a

few (Lofty et al., 2017).

Teaching patients about checking blood glucose levels regularly, the importance of taking

medications, coping mechanisms, and overall understanding and managing the disease will help

patients to lead healthier lives. It is crucial to know a patient's educational level when teaching

begins and to assess learning frequently. Difficulties may arise if patients are unable to

comprehend teaching. In these cases, the educators will need to work with the patient and

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understand how they best learn and apply the education in a form that is understandable to the

patient.

Treating the depression may necessitate placing the patient on medications. Including

psychotherapy may also be helpful. Support groups may also be beneficial. Feeling physically

good with diabetes is half the battle and feeling mentally sound is the other half (American

Diabetic Association [ADA], 2021). Not all patients are willing to admit they need help, and not

all accept help. They may be embarrassed or not inclined to share their feelings with others. This

may cause a challenge in getting help.

Current Outcomes Change Strategies Expected OutcomesPatients who are diagnosed with diabetes do have adequate education regarding kidney disease and treatment for depression:

a) Many patients do not know the signs and symptoms of kidney disease

b) Many patients with diabetes experience depressive symptoms that are related to poor blood glucose control

To ensure patients receive thecare they need, specific measures should be met:

 Signs and symptoms ofkidney disease should be discussed with patients.

 Support groups need tobe accessible to patients who could benefit from the help

 Medications for depression & urine home kits for testing

Patients with diabetes will have appropriate access to healthcare providers and support groups to help with their physical and mental well-being :

a) Patients will have Blood work drawn every 2-3 months to assess kidney functionand blood glucose averages (Centers for Disease Control and Prevention [CDC], 2021)

b) Patients with depression will have help through medication, therapy, and support groups (American Diabetic Association [ADA], 2021).

Conclusion

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Diabetes, if not appropriately managed, can lead to heart and kidney issues, blindness,

loss of limbs, and even death. When patients are appropriately educated on diabetes and the other

risk factors related to the disease, they are more likely to live longer. Helping patients who

develop depression due to the stress and emotional toll diabetes can have on them improves their

quality of life. All patients should have access to the healthcare and education they deserve,

regardless of socioeconomic status. Assuming a patient does not want or can not afford

treatments or medications places that patient in a position for increased complications. Making

care easy to access and understand will help all patients suffering from diabetes and its

comorbidities.

Having an open and trusting relationship with their healthcare provider will enable a

patient to feel free to discuss issues and concerns. They may not want to take medications for

depression or seek out support groups due to the stigma attached to reaching out for help

(Martinez et al., 2017). A patient with an interprofessional team caring for them will have the

best chance of succeeding and managing their diabetes.

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References

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Centers for Disease Control and Prevention. (2021, August 10). Diabetes education and support.

https://www.cdc.gov. https://www.cdc.gov/diabetes/managing/education.html

Formosa, C., & Muscat, R. (2016). Improving diabetes knowledge and self-care practices.

Journal of the American Podiatric Medical Association, 106(5), 352–356.

https://doi.org/10.7547/15-071

Huang, M.-C., Hung, C.-H., Yu, C.-Y., Berry, D. C., Shin, S.-J., & Hsu, Y.-Y. (2016). The

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of Advanced Nursing, 73(4), 943–954. https://doi.org/10.1111/jan.13194

Lofty, M., Adeghate, J., Kalasz, H., Singh, J., & Adeghate, E. (2017). Chronic complications of

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McFarlane, P., Cherney, D., Gilbert, R. E., & Senior, P. (2018). Chronic kidney disease in

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National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Diabetes Statistics.

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