PICOT: For adult patients diagnosed with type 2 diabetes at a Diabetic Specialty Clinic,

PICOT: For adult patients diagnosed with type 2 diabetes at a Diabetic Specialty Clinic, does implementation of the 2021 American Diabetes Association Recommendation # 5: Diabetes Self-Management Education and Support impact self-care behaviors in 8-10 weeks?
Our discussion for this week focuses on the DNP-prepared healthcare systems leader. What is the impact of the DNP-prepared healthcare systems leader on the healthcare systems of today?
The DNP-prepared healthcare systems leader is essential to the healthcare delivery system. DNP-prepared leaders impact the healthcare delivery system by transforming health care with innovations that improve patient health outcomes, using evidence-based guidelines and interventions through interprofessional collaboration.
How do you anticipate integrating this role into your current or future career?
I hope to improve healthcare outcomes using cost-effective initiatives to transform the healthcare delivery system. I plan on integrating my role as a DNP-prepared healthcare systems leader by using the AACN’s (2006) eight essential roles of doctoral education. Also, by using my terminal degree to educate the future nurses of America.
In your opinion, what is needed for successful professional identity formation in DNP students to achieve healthcare systems leadership roles after graduation?
The DNP student can achieve the components of a healthcare system leader by showing competence in informational technology (IT), informatics, leadership capability, advocating for healthcare policy, and subject matter experts to transform the healthcare delivery system.
For students in the Simulated Case Study:
Case Study: Weekly discuss implementing your proposed evidence-based practice change project during the COVID-19 pandemic:
Discuss best practices for implementing evidence-based practice/ guidelines with references sufficient to support best practice.
Providing a detailed record of expectations in each area of training is essential for implementation. Having a compliance checklist (Appendix A) to follow can also be beneficial to implementation to ensure that the project is implemented as envisioned.
Discuss strategies for overcoming barriers in implementing evidence-based practice with references sufficient to support strategies.
The DNP project manager should consider barriers carefully to project implementation and success. Potential barriers should be discussed with the project team and stakeholders to address alternative plans to ensure implementation success and future sustainability initiatives.
The authors Onge et al. (2020) notes the following can be barriers towards project implementation: 1) Logistical burdens- cost, resources, training; 2) Lack of data or evidence-supported practices, 3) Time of project implementation, and 4) Improper data analysis to support sustainability (Onge et al., 2020)
Week 2 in NR707 – Discuss
Discuss your formative evaluation plan as you are meeting with your participating staff and observation – how are you providing feedback?
What is your plan for formative evaluation in this pandemic situation?
An example of Formative evaluation of my DNP project would be the DSMQ tool used in pre-implementation and post-implementation to assess self-management behavior of patients diagnosed with diabetes.
An example of a Summative evaluation of my DNP project would be the compliance checklist below to assess the interventions of self-management behavior. Also, a summative evaluation is taking the data analysis and transferring the data into clinical practice
During week 2, in a simulated scenario when your formative evaluation plan reveals not all of the staff have implemented the evidence-based intervention. What is your next step?
Implementation of evidence-based interventions is essential to improving healthcare outcomes. Role allocation is vital to the success of project implementation. Each team member should accept their role in project implementation and support the evidence for successful implementation. Mathieson et al. (2018) note that the project team should collaborate and share ideas and information to ensure project success.
What are you learning about project implementation? What issues have you identified? How will you address these? As examples:
You identify that the staff needs more information about evidence-based practice. What will you do?
If the project team needed more information about the evidence-based interventions of the project, discussing why evidence-based interventions improve the healthcare delivery system would be a great start. Alqahtani et al. (2019) note that evidence-based practices are expected and recommended by governing agencies to improve the quality and cost of the delivery of healthcare. I would also inform the project team that the chosen intervention is backed by the American Diabetes Association standard number five (ADA, 2021), which supports the project PICOT question.
You identify that staff needs more information about the evidence-based intervention. What will you do?
If the staff required more information about the evidence-based intervention, I would go through the appraisal steps of the evidence-based intervention through literature analysis. Evidence appraisal is crucial to project implementation and success, and ensuring data analysis has successfully identified and record implementation success is required for sustainability. If more information were needed about the evidence-based intervention, I would provide appraised articles from random controlled trials (RCT), cross-sectional studies, and systematic reviews used to appraise the evidence-based intervention. Confirming the PICOT question that patient-centered self-management programs are integral to optimizing self-management behaviors.
You identify that you need to provide remedial training. How will you accomplish this?
Though I do not foresee any remedial training for the project, if remedial training is needed, I would review the PowerPoint presentation in the pre-implementation phase and reinforce the project interventions with appraised research evidence. Decipher where the break-in communication is and restate the objective of the project. Also, I would have the team verbalize their understanding of the project in their own words.
In your simulated Case Study some staff state “I am too busy” or “I do not see a need for change since the ‘way we have always done it’ works fine.” How will you address this?
Opposition to change is natural. Change may often come from insecurities, change in culture, and threatening to one’s routine. Kotter’s (1996) change model addresses the eight steps in the process of change and has been used by many institutions when implementing change. The eight steps are: 1) increase urgency, 2) build guiding team, 3) develop the vision, 4) communicate for buy-in, 5) empower action, 6) create short term wins, 7) do not let up, and 8) make change stick. Forming a coalition through involvement and commitment among team members is essential, and rewarding team members for endorsing change and supporting the process.
Also, using statistics of incidence and prevalence is an option for addressing the need for change, and reviewing data conferring that the project intervention selected can also be helpful during project implementation.
What additional resources may be necessary for a successful implementation?
Creating an atmosphere of change efforts to improve outcomes is essential while looking at the sustainability of project implementation. Sharing data analysis from other programs that support the proposed intervention would show the team that other institutions/agencies have implemented this intervention and improved patients’ health outcomes. Also, placing the project on a timeline is essential for successful implementation.
You have opposition or pushback from the nursing staff about making a change in practice during a pandemic crisis, how would you respond to this pushback?
Opposition to change is nothing new. However, implementing change during a pandemic crisis can be challenging. Jain et al. (2018) note that change can come with new possibilities, rules of practice, and priorities which can be a form of intimidation. Some strategies to implement change have management support, data to support the need for change, team involvement, effective communication of the vision, training, and addressing barriers towards implementation.
Also, allowing team members to communicate frustrations by voicing opinions can relieve some frustration. And asking what ideas any team members may have to resolve or alternatives while solidifying that the program implementation will go forward, but suggestions for success are always welcomed. The participation and commitment of team members are also essential to project implementation.
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References
American Association of Colleges of Nursing. (2006). Essentials of doctoral education for
advanced nursing practice.
Alqahtani, N., Oh, K., Kitsantas, P., & Rodan, M. (2019). Nurses’ evidence-based practice knowledge, attitudes, and implementation: A cross-sectional study. Journal of Clinical Nursing, 29, 274-283. http://doi.org/10.1111/jocn.15097 (Links to an external site.)
Jain, P., Asrani, C., & Jain, T. (2018). Resistance to change in an organization. IOSR Journal of Business and Management, 20(5), 37-43. http://doi.org/10.9790/487X-2005073743 (Links to an external site.)
Kotter, J. (1996). Kotter’s eight-step model of change. Retrieved from https://www.managementstudyguide.com/kotters-8-step-model-of-change.htm (Links to an external site.)
Mathieson, A., Grande, G., & Luker, K. (2018). Strategies, facilitators, and barriers to
implementation of evidence-based practice in community nursing: A systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20(6), 1-11. http://doi.org/10.1017/S1463423618000488 (Links to an external site.)
Onge, C., Lachiver, E., Langevin, S., Boileau, E., Bernier, F., & Thomas, A. (2020).
Lessons from the implementation of developmental progress assessment: A scoping review. Medical Education in Review, 54(10), 878-887. http://doi.org/10.1111/medu.14136 (Links to an external site.)