Assessment 2: Problem Statement (PICOT)
Name
Capella University
FPX 6030: MSN Practicum & Capstone
Instructor’s Name
December, 2023
In this capstone project assessment, the focus is on developing a comprehensive problem statement utilizing the Problem-Intervention-Comparison-Outcome-Time (PICOT) approach to nursing research. The scenario involves Anne, a member of a newly formed Quality Initiative Committee, tasked with identifying a healthcare need within the organization. The identified need centers on addressing the increasing incidence of falls in the geriatric unit.
This introduction sets the stage for the subsequent exploration of a multifaceted problem statement, encompassing the analysis of a health promotion or management need, the description of the target population and setting, an overview of interventions, and a literature review to substantiate the identified need.
In adults (P), how does a structured diabetes self-management education program (I) compared to standard diabetes education (C) influence glycemic control, as measured by HbA1c levels (O), within a six-month period (T)?
• Population (P): Adults with diabetes
• Intervention (I): Structured diabetes self-management education program
• Comparison (C): Standard diabetes education
• Outcome (O): Glycemic control, measured by HbA1c levels
• Time Frame (T): Within a six-month period
This PICOT question is structured to inquire about the effectiveness of a specific intervention (structured diabetes self-management education program) compared to a standard approach in improving glycemic control among adults with diabetes, within a defined time frame of six months.
Part 1: Problem Statement
Need Statement
In adults with diabetes, there is a need for improved glycemic control to prevent complications and enhance overall health outcomes (Jiang et al., 2019). Current diabetes education programs may not provide adequate structure or effectiveness, leading to suboptimal glycemic control.
Assumptions
The existing standard diabetes education programs may lack the necessary structure or comprehensiveness required for optimal diabetes self-management. A structured diabetes self-management education program has the potential to enhance patient understanding and adherence, leading to improved glycemic control (Heller et al., 2020).
A six-month period is sufficient to observe significant changes in glycemic control based on the implementation of a structured diabetes education program.
HbA1c levels are a reliable indicator of glycemic control and an appropriate outcome measure for assessing the effectiveness of diabetes education programs. The proposed intervention is applicable and beneficial for adults with diabetes, as they are the focus of the study.
The standard diabetes education methods might not be adequately addressing the diverse needs and preferences of individuals, leading to varied levels of engagement and outcomes (Heller et al., 2020). The success of the intervention is contingent on participants’ adherence to the structured diabetes self-management education program.
Population and Setting
Implementing the Plan-Do-Check-Act (PDCA) cycle is a quality improvement method that could significantly impact patient outcomes in diabetes management. The PDCA cycle involves systematically planning a change, implementing it on a small scale (pilot), checking its effects through data analysis, and acting on the results by making necessary adjustments before full-scale implementation.
In the context of diabetes education, the PDCA cycle can be applied by developing a structured self-management education program, implementing it with a small group of participants, monitoring their glycemic control outcomes, and refining the program based on the observed results (Gao et al., 2021).
Working on the identified need of improving diabetes management through a structured education program faces potential challenges. Firstly, gaining full participation and engagement from the target population, adults with diabetes, might be challenging due to varying levels of health literacy, socioeconomic factors, and individual motivation (Gehlawat et al., 2019).
Additionally, there may be resistance to change from both healthcare providers and patients accustomed to traditional education methods. The implementation of a structured program could also face resource constraints, such as limited access to educational materials or trained educators.
Intervention overview
One intervention to drive quality improvement in diabetes management is the implementation of a Structured Diabetes Self-Management Education Program (SDSMEP) (Gamboa et al., 2019). This program would involve a carefully designed curriculum addressing various aspects of diabetes self-care, including medication management, dietary choices, physical activity, and monitoring of blood glucose levels.
Trained educators would deliver the program through diverse formats, accommodating different learning preferences. Regular follow-up sessions, support groups, and technology-assisted tools could enhance participant engagement.
However, weaknesses may include challenges in ensuring consistent attendance, particularly for individuals with limited resources or competing priorities. The effectiveness of the program might also be contingent on the availability of skilled educators and access to educational materials, potentially limiting scalability (Gamboa et al., 2019).
Another intervention could be the integration of digital health platforms, such as mobile applications or web-based resources, to complement traditional diabetes education.
These platforms could offer personalized educational content, real-time monitoring features, and interactive tools to promote self-management (Gamboa et al., 2019).
Despite potential benefits, weaknesses may include limited accessibility for individuals with lower digital literacy or socioeconomic disparities. The success of digital interventions may also hinge on technology acceptance among the target population, and there is a risk of incomplete engagement if individuals are not comfortable or familiar with digital tools.
Comparison of Approaches
One potential interprofessional alternative to the initial intervention of a Structured Diabetes Self-Management Education Program (SDSMEP) is the incorporation of a Collaborative Care Model (CCM). The CCM involves a team of healthcare professionals, including nurses, dietitians, pharmacists, and primary care providers, working together to deliver comprehensive diabetes care (De La Rosa et al., 2019).
This alternative recognizes that diabetes management encompasses various facets that may benefit from the expertise of diverse professionals.
However, weaknesses may arise in terms of communication and coordination among the interprofessional team members, potentially leading to fragmented care if not well-implemented. Additionally, resource constraints, such as limited availability of healthcare professionals or funding, may hinder the feasibility of a Collaborative Care Model in certain settings.
Another alternative could involve the establishment of Diabetes Peer Support Groups, where individuals with diabetes share experiences, insights, and practical tips for self-management (De La Rosa et al., 2019).
This interprofessional approach may involve trained peer leaders, nurses, and other healthcare professionals facilitating these groups. While peer support can be valuable, potential weaknesses include variations in the quality and consistency of information shared, and challenges in ensuring accurate and evidence-based guidance.
Moreover, peer-led interventions may face limitations in addressing complex medical questions that individuals with diabetes may have. Balancing the benefits of peer support with the need for accurate medical information and ensuring the sustainability of peer-led programs are essential considerations when exploring this interprofessional alternative.
Initial Outcome Draft
The defined outcome related to a health policy for the intervention of a Structured Diabetes Self-Management Education Program (SDSMEP) is the establishment of a comprehensive diabetes education policy within the healthcare organization. The purpose of this outcome is to institutionalize and standardize evidence-based diabetes self-management education across the healthcare system (Jiang et al., 2019).
The intended accomplishments include increased accessibility to high-quality diabetes education for all patients with diabetes, fostering patient empowerment, and ultimately improving glycemic control and reducing diabetes-related complications.
Assess the extent to which the diabetes education policy is successfully implemented across various healthcare settings and patient demographics. Examine whether the policy ensures equitable access to diabetes education resources for diverse patient populations, considering factors such as socioeconomic status, cultural diversity, and geographical location. Measure the level of patient engagement and empowerment achieved through the education program, including the adoption of self-management practices and informed decision-making.
Evaluate improvements in glycemic control and reductions in diabetes-related complications among patients who have participated in the structured education program (Jiang et al., 2019). Assess healthcare providers’ adherence to the policy, including the consistency and quality of diabetes education delivery, to ensure alignment with evidence-based practices.
Time Estimate
A realistic and feasible time frame for the development and implementation of the Structured Diabetes Self-Management Education Program (SDSMEP) could be approximately 12 to 18 months.
The first six months would be dedicated to the development phase, including the creation of the educational curriculum, training of educators, and establishment of support mechanisms such as digital platforms or peer support groups.
The subsequent six to twelve months would involve a phased pilot implementation to assess the program’s effectiveness in a controlled environment. Finally, the remaining time would be allocated for full-scale implementation and continuous refinement based on ongoing evaluation and feedback.
Areas of Uncertainty
• The time required for training educators might vary, and uncertainties in the availability of skilled educators could impact the implementation schedule.
• The level of patient engagement and adherence to the education program may be challenging to predict, influencing the success and timeline of the intervention.
• If the intervention includes digital platforms, uncertainties in the integration of technology and potential challenges in digital literacy among the target population could affect the development and implementation timeline.
• The time required for obtaining necessary approvals, such as ethical clearances and regulatory compliance, may vary, introducing uncertainties in the development and implementation schedule.
Part 2: Literature Review
To validate the identified need for improved glycemic control in adults with diabetes and the appropriateness of implementing a Structured Diabetes Self-Management Education Program (SDSMEP), a comprehensive analysis of current evidence has been conducted.
The evidence, drawn from recent peer-reviewed studies, clinical guidelines, and reputable health organizations, consistently supports the significance of structured diabetes education in enhancing self-management and glycemic control (Azmiardi et al., 2021).
The relevance of the evidence is underscored by its alignment with the specific characteristics of the target population—adults with diabetes—and the healthcare setting. The evidence is current, reflecting the latest advancements in diabetes management and education.
The sufficiency of the evidence is evident in the wealth of data demonstrating the positive impact of structured education on patient outcomes. Trustworthiness is established through the reputable sources of the evidence, including well-established medical journals and authoritative health institutions, ensuring the reliability of the information and its applicability to the proposed intervention.
Healthcare Policy that Impacts the Approach to Address an Identified Need
The synthesis of resources pertaining to health policy, healthcare technologies, and communication strategies that could influence the approach to address the identified need for improved glycemic control in adults with diabetes reveals a comprehensive landscape (Pai et al., 2021).
Health policy resources from government health agencies, such as the CDC and AHRQ, provide guidelines endorsing patient education as a crucial component of diabetes management. Additionally, research articles from reputable journals emphasize the importance of policy support for structured education programs.
Healthcare technologies, ranging from mobile applications to telehealth platforms, showcase innovations in diabetes management, facilitating individualized education and remote monitoring. Communication strategies, as depicted in patient education materials and community outreach programs, highlight diverse approaches to reach and engage the target population.
While the available resources offer valuable insights, there is a notable absence of specific details regarding the integration of health policy recommendations into practical implementation strategies. Missing information includes the specific policy components that support the scalability and sustainability of structured education programs, as well as guidelines for ensuring equitable access to these programs across diverse demographic groups (Milat et al., 2020).
Additionally, there is a gap in information regarding the potential challenges and solutions related to the integration of various healthcare technologies in resource-constrained settings. Bridging these information gaps will be essential for crafting a nuanced and context-specific approach to implementing the Structured Diabetes Self-Management Education Program within the existing health policy framework.
Conclusion
This capstone project assessment has provided a thorough exploration of a pertinent healthcare need, specifically the increasing falls in the geriatric unit, through the lens of the PICOT approach. The problem statement encompassed an analysis of the need, described the target population and setting, outlined interventions, and substantiated the need with a literature review.
The proposed Structured Diabetes Self-Management Education Program (SDSMEP) emerged as a potential intervention, emphasizing the importance of evidence-based, comprehensive education in diabetes management. The time frame for development, potential interprofessional alternatives, and the synthesis of diverse resources further enriched the understanding of the identified need and intervention.
This assessment serves as a critical precursor to the capstone project, setting the stage for an in-depth exploration of nursing research, quality improvement, and patient-centered care to drive positive outcomes in healthcare practice.
References
Azmiardi, A., Murti, B., Febrinasari, R. P., & Tamtomo, D. G. (2021). The effect of peer support in diabetes self-management education on glycemic control in patients with type 2 diabetes: A meta-analysis. Epidemiology and Health, e2021090. https://doi.org/10.4178/epih.e2021090
De La Rosa, M., Pitts, S., & Chen, P. (2019). An interprofessional collaboration of care to improve clinical outcomes for patients with diabetes. Journal of Interprofessional Care, 34(2), 1–3. https://doi.org/10.1080/13561820.2019.1643297
Gamboa, E., Mateo, M., Retana, L., Vrotsou, K., del Campo, E., Sánchez, Á., Martínez, C., Arbonies, J. C., Portu, M. Á., Piñera, K., Zenarutzabeitia, A., Urquiza, M. N., Méndez, T., Oses, A., Aguirre, M. B., & Rotaeche, R. (2019). Efficacy of a self-management education programme on patients with type 2 diabetes in primary care: A randomized controlled trial. Primary Care Diabetes, 13(2), 122–133. https://doi.org/10.1016/j.pcd.2018.10.001
Gao, Y., Chen, X., & Kang, L. (2021). The effect of Plan-Do-Check-Act cycle nursing management of gynecological surgery: A systematic review and meta-analysis. Annals of Palliative Medicine, 0(0). https://doi.org/10.21037/apm-21-1590
Gehlawat, M., Lakshminarayanan, S., & Kar, S. S. (2019).
Structured diabetes education program for improving self-care behavior in primary care settings of Puducherry: Evidence from a randomized controlled trial. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 44(2), 107–112. https://doi.org/10.4103/ijcm.IJCM_192_18
Heller, S. R., Gianfrancesco, C., Taylor, C., & Elliott, J. (2020).
What are the characteristics of the best type 1 diabetes patient education programmes (from diagnosis to long‐term care), do they improve outcomes and what is required to make them more effective? Diabetic Medicine, 37(4), 545–554.
https://doi.org/10.1111/dme.14268
Jiang, X., Jiang, H., Lu, Y., Liu, S., Wang, J., Tang, R., & Li, M. (2019). The effectiveness of a self‐efficacy‐focused structured education programme on adults with type 2 diabetes: A multicenter randomized controlled trial. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.14908
Milat, A., Lee, K., Conte, K., Grunseit, A., Wolfenden, L., van Nassau, F., Orr, N., Sreeram, P., & Bauman, A. (2020). Intervention scalability assessment tool: a decision support tool for health policy makers and implementers. Health Research Policy and Systems, 18(1). https://doi.org/10.1186/s12961-019-0494-2
Pai, L., Chiu, C., Liu, H., Chen, L., & Peng, T. (2021). Effects of a health education technology program on long-term glycemic control and self-management ability of adults with type 2 diabetes: A randomized controlled trial. Diabetes Research and Clinical Practice, 175, 108785. https://doi.org/10.1016/j.diabres.2021.108785
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