Out of the 34 million Americans that have diabetes, 90-95% of Americans have Type II (CDC, 2019). Unfortunately, only about 75 percent are aware that they have a diabetic condition. Gyawali et al. (2018) estimated that 8.8 million individuals every year with diabetes end up in hospitals in critical condition. Diabetes Type II is the seventh cause of death within the nation. This high figure needs much consideration into the interventional strategies to contain the diseases, or even at least help the patients. Diabetes Type II has affected many populations, with an increasing percentage being taken seriously ill over the previous two decades, showing the rising occurrence of the disease (White, 2016; Gruss et al., 2019). An effective intervention is necessary to eliminate or reduce all diabetic problems like hypoglycemia and hyperglycemia in patients diagnosed with the condition while being attended to in the health facilities.
Overview of Selected Population
Adults who suffer from uncontrolled type II diabetes
Hyperglycemia- high levels of sugar/glucose: Adults with hyperglycemia experience high blood glucose levels from time to time. Individuals with this condition are exposed a diverse kind of chronic cases such as stroke, heart attack, circulation disorders, and others.
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Hypoglycemia - low levels of sugar/glucose: Adults with hypoglycemia display extremely low levels of blood glucose that drop even below 70mg/dL. Adults who utilize insulin or particular kinds of oral diabetes medication experience this condition (Gruss et al., 2019). Complications that accompany the condition include seizures, unconsciousness, acute confusion, or even death.
Adults who do not have healthy lifestyles or behaviors
Most adults in America exhibit poor lifestyle habits such as poor sleeping quality, smoking, and alcohol abuse. They also have poor dietary quality with most of them not endeavoring to take healthy foods. A relationship exists between adults’ lifestyle and their exposure to type II diabetes. Most of them do spend most of their time sitting and not indulging in exercises. The alarming rate of diabetes type II cases among the citizens of the United States is not a surprise (White, 2016). The people in the nation have been living longer, providing the basis for the increased occurrence of several varied chronic diseases such as diabetes type II. The major risk factor considered for diabetes type II is age, where the elderly individuals are more exposed to the condition and several other permanent medical histories.
Disease Specific Data
Diabetes
Diabetes is a chronic illness that comes with several complications, including three kinds of diabetes: type I, type II, and gestational one. For the case of this intervention project, the emphasis would be on type II diabetes. An individual’s body characterizes type II diabetes, not being able to use insulin appropriately, creating a complication for the body not to regulate its regular blood sugar (White, 2016). In short, type II diabetes is a chronic condition that affects the way the body metabolizes glucose. About 90 percent of patients have type II diabetes, which is the reason it is the emphasis of this interventional project (Brown, 2019). Type I diabetes occurs when the body attacks itself so that one’s body seizes from creating insulin, and gestational diabetes is experienced by pregnant mothers creating health complications for the infant and, in most cases, diminishes following the birth of the baby. Therefore, the most prevalent examples of diabetic conditions are Type II diabetes that affects the majority of people.
Out of the 34 million Americans that have diabetes, 90-95% of Americans have Type II (White, 2016). Regrettably, about 86 million of the American population have pre-diabetes, and 80 percent of those are not aware of it (Golden et al., 2017). These frightening statistics indicate that diabetes will sometimes fail to be diagnosed among those that necessarily are victims of it. The patient goes to the hospital with indications of extreme thirst, recurrent urination, a wound on the part of the body that is persistent, or weariness (McLeod, 2018).
Type II diabetes is most common in adults over the age of 45. However, in current times more and more children have the disease (Golden et al., 2017). Gyawali et al. (2018) determined that patients (especially for adults above 45 years old) with cases of diabetes, including type II, are also accompanied by an alarming level of high blood sugars, even without knowing their condition. This calls for more creation of awareness of the population so that they can understand their condition ahead and consider interventional measures before it is too late.
Who is at risk
Several risk factors exist that expose people to type II diabetes condition. The first risk factor is a family history of the disease. A person becomes more susceptible to developing type II diabetes conditions because one of his family members was a victim of the disease. As such, the person shares the genetic elements of the family member who had the disease and may develop the condition particularly if their ages go beyond 45 years (Gruss et al., 2019).
Unhealthy lifestyle behaviors are the major cause of type II diabetes among individuals. The person has poor eating habits that give chance to them being overweight or obese. They fail to engage in physical activities or exhibit sedentary lifestyles (White, 2016). Such practices predispose one to develop type II diabetes and even other opportunistic diseases.
Certain ethnicities and races are more susceptible to type II diabetes than others are. This type of diabetes is more common among African-Americans and Asian-Americans than the whites. However, in the US, race, and ethnicity, are linked with also several other risk factors for type 2, such as a family history of the disease (Gruss et al., 2019). Research has determined that type II diabetes can be influenced to come late in one’s life or even eliminated entirely by about 58 percent by dropping a significant level of weight and being involved in physical activities.
Effects of diabetes on the body
Some effects of diabetes of the body of patients include susceptibility to cardiovascular diseases, retinopathy, and neuropathy. Cardiovascular diseases include asthma, heart diseases, and others. Type II diabetes gives way for other complications such as chronic kidney illnesses, wounds that will are adamant to healing that could even cause the limbs to be amputated in the process, heart attacks, or stroke (Golden et al., 2017). Most patients are usually treated for diabetes ketoacidosis (DKA), which is a very critical condition that would need treatment with intravenous insulin and fluid. Such a stage could have been avoided if the patient discovered the condition earlier in time and properly managed it.
Diabetes also causes retinopathy in the patient. This is a result of inappropriately managed glycaemia, blood pressure as well as lipid levels. DKA creates chances for retinopathy to occur, which is referred to as diabetic eye disease (White, 2016). The reduced prevention levels lead to persistent resistance of the body tissues of the patient to insulin (Garner et al., 2019). However, these admissions to the hospitable to critical cases of diabetes, which could have been prevented, are what take enormous costs of the health field. The costs range from 552 million dollars for those without critical conditions to 1821 million dollars for those with ketoacidosis (Golden et al., 2017).
There is also neuropathy, which is a condition whereby, the patient experiences nerve damage. Type II diabetes causes the patient’s nerves not to respond to pain or any triggers (Gruss et al., 2019). These complications also make the patients exposed to other risks of morbidity and mortality. The health practitioners must endeavor to enhance the health of the American population through proper intervention within the health facilities.
Suggested Intervention
Education is the best way to manage chronic conditions that would be essential to improve population health. The patients should be made aware of the benefits involved in physical activities (Golden et al., 2017). Moderate to vigorous physical activities, leisure time physical engagement would help some from developing type II diabetes and other metabolic conditions. Physical exercise will help to manage body weight, visceral fat accumulation into one's body, and insulin tolerance. Regular exercise will also lead to reduced blood pressure, enhanced glucose tolerance, and lipid profile. Thus, moderate to vigorous physical exercise could be more beneficial to containing metabolic and chronic conditions. Therefore, nurses can capitalize on creating awareness on the need to embrace physical activity and have better nutritional courses as part of one's lifestyle.
Dietary factors are significant in the management and prevention of type II diabetes. Patients and individuals should follow nutritional guidelines for type II diabetes and maintain an optimal eating pattern. The nurses should create more awareness of people taking low-fat diets with a high macronutrient quality (Garner et al., 2019). People can be trained to avoid processed foods with many starches and sugars and embrace healthy foods that would primarily contain type II diabetes.
Setting
With the present experiences gained from working with the surgical intensive care unit in a hospital is one of the states in America, patients with type II diabetes can be helped. Education on the essence of physical activities in a person’s life, as well as proper nutritional courses, are critical as an interventional project. This can be ensured through establishing a gym and nutritional center in the community. This setting will target patients with chronic illnesses such as type II diabetes. The nutrition center has a nutritionist that pieces of advice the patients or people on a healthy meal plan and nutritional course. The community gym has a gym instructor who is guiding the patients into various exercises. The healthcare will monitor the intervention program entail consistent exercising and eating plan for three months, with every participant having his or her own schedules.
The gym will have various equipment so that the entire body can be exercised equally. When the community members embrace a healthy meal plan and become active, they can keep their blood glucose level to optimum and all conditions of diabetes type II. The community gym will target majorly the people that overweight or have obesity. Inside the gym, there will be offices for the health care team to help the people have a weight-loss plan. According to Gruss et al. (2019), aerobic exercises would be in this gym center, along with the equipment such as the treadmills and the bikes. The health care team will also provide an environment for strengthening and stretching exercises. The nutritionist would have a number of meal plan methods on charts within the gym center so that participants may understand how to take fewer calories. Patients will be able to choose healthy foods with a reduced amount of calories, fat, and sugar, as suggested in the charts.
Cultural Considerations
Cognitive and socio-economic factors
Considering the socio-economic factors, the CDC reports that 11.8 million of the elderly population of age 65 years and above have diabetes within the United States. People at this age have a poor lifestyle and low income. Diabetes is one of the main causes of lower limb amputations, blindness and kidney failures, and other cardiovascular diseases among people of this age. Diabetic eye illnesses were progressively increased in African Americans at 27 percent, followed by Latinos at 25, and a mixed race-ethnicity is forming 26 percent (Gruss et al., 2019). The Asians, Filipinos, and whites formed 23, 21, and 19 percent, respectively (Golden et al., 2017).
Dietary/ religious beliefs
The susceptibility for type II diabetes heightens with age and ethnic diversity. This is further triggered by cognitive and socio-economic factors and dietary/ religious beliefs. Religious and dietary beliefs can be better understood in the context of ethnicities. Gruss et al. (2019) determined that the whites are least affected with diabetes, forming 7 percent of the diabetic population. Most whites do junks, but they are at the same time aggressive in physical exercises. Filipinos have the highest rate at 16 percent, while Americans and Latino following behind both at 14 percent (Golden et al., 2017).
As far as religious beliefs are concerned, t he interest to enhance the lives of individuals with diabetes and other opportunistic diseases is in line with the divine mandate. The verse that is predominant regarding caring for people is 3 John 1:2, “Beloved, I wish above all things that you may prosper and be in health, even as your soul prospers.” This verse helps us to understand that God is concerned about our physical health as much as He does to our spiritual lives. In fact, through the stripes of Jesus, we are assured of our healing. Patients should be concerned with how they take care of their bodies because God would want them healthy. It is when one is fit and healthy that he can be of help to another. We must glorify God in our bodies, and we should be careful about the kinds of foods that we take. Patients should also not indulge in drug and substance abuse since these are harmful to our bodies, which are the temple of God.
Most people think that God just concentrates on our spiritual beings and ignore our bodies. In fact, with an excellent spiritual disposition, a person will have peace and not indulge in activities that are harmful to his or her body (White, 2016). We have better health outcomes if we treat our whole being carefully. We need to be careful about how we carry out ourselves. 1 Timothy 4:8 also recognizes that bodily exercise profits. It says, “For bodily exercise profits little : but godliness is profitable unto all things, having promise of the life that now is, and of that which is to come.” Therefore, the biblical perspective does not condemn indulgence in exercise but instead acknowledges that it has profit, but not as much as godliness. A nurse should have such a perspective while handle patients to take better care of them.
Budgetary Needs
Diabetes management in the nation forms a large percentage of healthcare spending, especially as it concerns advertisement and information pamphlets. Even though establishing a community gym and nutritional program would attract many costs, the benefits of the move will help health care institutions save a lot of money. Gyawali et al. (2018) in their study established that creating awareness is costly. Funds are needed to do advertisements for the program and produce information pamphlets (McLeod, 2018). The community members could easily find all the details about the program and its objectives through reading the pamphlets. White (2016) proudly affirms that better advertisements made through websites and other platforms will save hospital frameworks millions of dollars by bringing down susceptibilities and costs of care.
Another spending would be on facility usage. There would be critical cases of type II diabetes patients that would require cardiac and vascular surgery. The facility would ensure savings by indulging the patients in the interventional programs so that there are lessened readmissions because of diabetes (Garner et al., 2019).
There is also spending allocated for miscellaneous supplies. This entails spending on equipment for the community gyms such as treadmills, bikes, dumbbells, and others. The hiring of rooms for the gym and offices of the physicians as well as other miscellaneous needs would require some money allocation.
Lastly, there is a need to allocate funds for nutritional and physical trainers. To be able to implement the program successfully, the hospital must invest in the competent healthcare team. Recruiting talented and competent nutritional and physical trainers would require a huge part of the money. This will guarantee quality delivery and that the intervention is successfully implemented. However, if the nutritional and gym program is implemented, there is an eminent decrease in readmission rates, which will cause the hospital to save a lot of money that could have otherwise been spent to treat type II diabetes patients subsequently.
Possible Funding Sources
Possible funding could emanate from grants and government. Grants include seeking funding from entities such American Diabetes Association for research, a channel that the hospital can take up. A facility that is both a teaching and research hospital gives an added advantage. A proposal can be made through the hospital to finance research on intervention programs for patients with diabetes (McLeod, 2018). Another possible funding source is the Center for Disease Control and Prevention (CDC) grant money, which is apportioned through the government. In 2018, for instance, South Carolina received 50 to 100 million dollars from CDC grant funding (Gruss et al., 2019). The fund could be helpful in the health facility’s diabetic care unit (White, 2016). CDC currently runs a program with the name "diabetic belt" that comprises of 644 counties and 15 states. All is needed is to make a good proposal on the need for the funding so that CDC may find it a worthy investment in a bid to reduce type II diabetes cases in the American population.
Timeline for implementation
The implementation will take place for 18 months, and evaluation would be to check the decrease in body weight and blood sugar levels as one indulges in exercise and proper nutritional plan. Eighteen months is sufficient to determine if the program is effective in inducing weight loss and glucose levels and increasing the length of the healthy stay of the diabetic patients. The first six months would entail establishing the program; bring trained nutritional therapists onboard and physical trainers, including the gym instructors. The subsequent six months would ensure that participants are provided with proper training and information to begin their journey to a healthier life. In the last six months, the participants will implement the knowledge gained on their own with weekly health evaluations and weigh-ins being facilitated by the health team.
Evaluation methods
Participation surveys at the end of the end of second 6 months
Participation surveys at the end of six months will be done to use the feedback to ensure the program is working and can be scientifically proven. The program is also patient-centered both in and outside the hospital. Patients will enroll in specific programs and walk with one specific healthcare team to know what is expected of them. The health team can monitor the progress of the participants and their outcomes of the program and advise them on adjustments accordingly.
Weekly logs for blood glucose levels and weight loss
Weekly logs for blood glucose levels and weight loss are essential records to be kept consistently. Monitoring the gym exercises individually for every client has proved to be most effective and safe (McLeod, 2018). The patient is not at risk at any time when he progressively involves the weight loss exercises. The instructor ensures that he or she engages in proper exercises and at optimum levels.
QSEN implications
The Quality and Safety Education for Nurses (QSEN) project is a national program of equipping future nurses to have the necessary knowledge, skills, and perspective for the best quality care and, at the same time, be safe as they practice. Six quality and safety capabilities exist in the initiative, namely: patient-focused care, evidence-founded practice, quality enhancement, safety, informatics, cooperation, and collaboration (White, 2016). All these competencies are evident in the intervention project of educating people on engaging in physical activities and an exceptional nutritional course. One of the key principles in the community gym is to ensure quality and safety for both the patient and the healthcare team.
Evidence-based practice has been determined to engage the intervention of physical activity and proper health plans. Increased focus on evidence-based public health (EBPH) has numerous direct and indirect benefits, including access to more and higher-quality information on what works, a higher likelihood of successful programs and policies being implemented, greater workforce productivity, and more efficient use of public and private resources” (Brown, 2009). Teamwork is ensured through coordinating activities such as aerobic exercises to be attended by a group of participants. All patient data is also considered and personalized on every patient. This also entails have various kinds of exercise and food suggestions for every participant.
The improvement in participating in the program automatically assures better outcomes for the patients. With this link between two plans for the participants, great support for the evidence-founded improvement process exists. This comprises reminders and clinical decision support frameworks, automated computer order entry, and organizational change. For this program, every health team member must also collaborate with themselves and the patient to succeed in every step. Gyawali et al. (2018) established that training and utilizing present staff members to implement the education or creation of awareness is significant in settings that are not sufficiently staffed with specialists .
Conclusion
Diabetes is a national problem, if not a global one, that Americans need to endeavor communally to manage or even eliminate diabetes cases. There are several ways to eliminate type II diabetes, even before admission to the hospital. As also determined in this, some patients never know that they have type II diabetes condition. The intervention I proposed was the involvement in physical activities and having a healthy nutritional plan to enhance patient health outcomes and decrease incidences of hypoglycemic and hyperglycemic episodes within the hospital. Even if people may not afford the subsidized fees of the community gym and the nutritional advice, they can be informed of involving in light physical activities in their homes. This intervention will save hospitals millions of dollars in costs of diabetic care, whereas also reduce the susceptibility of contracting cardiovascular diseases as well as other opportunistic diseases. With proper implementation of the nutritional plan and involvement in physical activities, it will enhance patient safety and results thus improving the quality of care.
References
Brown, A. (2019). Intensive dietary lifestyle interventions in type 2 diabetes. Endocrine Abstracts . https://doi.org/10.1530/endoabs.61.ou6
Garner, N., Pascale, M., France, K., Ferns, C., Clark, A., Auckland, S., & Sampson, M. (2019). Recruitment, retention, and training of people with type 2 diabetes as diabetes prevention mentors (DPM) to support a healthcare professional-delivered diabetes prevention program: the Norfolk Diabetes Prevention Study (NDPS). BMJ Open Diabetes Research & Care , 7 (1), e000619. https://doi.org/10.1136/bmjdrc-2018-000619
Golden, S., Maruthur, N., Mathioudakis, N., Spanakis, E., Rubin, D., Zilbermint, M., & Hill-Briggs, F. (2017). The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes. Current Diabetes Reports , 17 (7). https://doi.org/10.1007/s11892-017-0875-2
Gruss, S., Nhim, K., Gregg, E., Bell, M., Luman, E., & Albright, A. (2019). Public Health Approaches to Type 2 Diabetes Prevention: the US National Diabetes Prevention Program and Beyond. Current Diabetes Reports , 19 (9). https://doi.org/10.1007/s11892-019-1200-z
Gyawali, B., Bloch, J., Vaidya, A., & Kallestrup, P. (2018). Community-based interventions for prevention of Type 2 diabetes in low- and middle-income countries: a systematic review. Health Promotion International , 34 (6), 1218-1230. https://doi.org/10.1093/heapro/day081
McLeod, S. (2018). Erik Erikson’s stages of psychosocial development. Retrieved from https://www.simplypsychology.org/Erik-Erikson.html
White, M. (2016). Population Approaches to Prevention of Type 2 Diabetes. PLOS Medicine , 13 (7), e1002080. https://doi.org/10.1371/journal.pmed.1002080
