Helping Newly Diagnosed Asian-Americans Cope With Type 2 Diabetes

¶ … Asian-Americans with newly diagnosed type 2 diabetes perceive barriers to implementing dietary and lifestyles changes to reduce A1C levels in the first 3 months after diagnosis"?

Method of obtaining necessary approval(s) and securing support from your organization's leadership and fellow staff.

One of the most difficult parts of effecting meaningful change in an organizational setting is obtaining the necessary approval from top management and then achieving "buy-in" from fellow staff members. Top management may be fearful of change because of the unknowns and potential additional costs and disruption to operations that may result while fellow staff members may be highly reluctant to willingly accept any changes in their day-to-day routines. In this regard, Kerber and Buono (2008) emphasize that, "Planned change, which has become an increasingly popular approach to change management, may arise from any level in the organization but ultimately is sponsored at the top" (p. 24).

In order to secure top management support, it is vitally important to actively involve them in the planning phases to the extent they deem necessary, and to ensure that they are made aware of the key advantages and benefits that will accrue to the adoption and implementation of the change initiative (Kerber & Buono, 2008). It is also important to ensure that contingency plans are in place to avoid any disruption of critical services during the implementation stages (Kerber & Buono, 2008). As Kerber and Buono point out, "Change leaders and implementers seek involvement in and commitment to the change by making extensive use of specific actions, identified through research and experience, that mitigate the typical resistance and productivity losses associated with directed change" (p. 25). In addition, besides convincing top management of what benefits and advantages of the change initiative for the organization, it is also helpful to educate management and fellow staff members concerning any "what's-in-it-for-them" aspects of the initiative (Kerber & Buono, 2008).

2. Description of current problem, issue, or deficit requiring a change.

Newly diagnosed Asian-Americans with type 2 diabetes may perceive barriers to implementing dietary and lifestyles changes that are intended to reduce A1C levels in the first 3 months after diagnosis unless the receive the appropriate education concerning the criticality of the need. Because nurses are also educators and serve on the front lines of delivering health care services, it is natural for nurses to provide these educational services to newly diagnosed Asian-Americans with type 2 diabetes to improve their adherence to changes in their dietary and lifestyle regimens. For example, Wu and Tung (2014) report that, "Diabetes is a chronic disease and is one of the common self-care diseases. Good self-care, including diet management, medication compliance, blood glucose monitoring, exercise participation and foot care, improves glycemic control and lowers the incidence and severity of diabetes complications" (p. 188). Fortunately, the majority of newly diagnosed type 2 diabetes patients readily understand that changes in their lifestyle and dietary habits are needed to manage this disease, but some patients fail to adopt the recommended changes for various reasons (Wu & Tung, 2014).

Although the reasons for poor adherence to recommended changes in lifestyle and dietary regimens vary from individual to individual, some of the overarching barriers to effective patient education identified by researchers to date has been a paucity of careful patient assessment concerning the their readiness for self-care as well as their motivational levels and precise individual management needs (Wu & Tung, 2014). These same barriers that affect the general population can also be reasonably posited to adversely affect the adherence levels among Asian-Americans who have been newly diagnosed with type 2 diabetes as well. In order to evaluate the effectiveness of a patient education initiative for this purpose, though, it will be necessary to collect benchmark data concerning the current levels of adherence of this population to prescribed changes in lifestyle and dietary regimens. Following the collection of this benchmark data, the effectiveness of the proposed solution described below can be evaluated periodically after implementation.

3. Detailed explanation of proposed solution (new policy, process, procedure, or education to address the problem/deficit).

The individual elements of the PICOT acronym are as follows: P. represents population of interest, I represents intervention, C represents comparison (comparing processes), O represents outcome (evaluating effectiveness of the process), and T. represents time as an element to provide structure (Burnett, 2013, p. 37). According to Burnett, "PICOT works like a filter, targeting efforts and narrowing the search for information as it applies to a specific patient care issue" (2013, p. 37). The PICOT statement that will guide the proposed patient education initiative is set forth in Table 1 below.

Table 1

PICOT statement for newly diagnosed type 2 diabetes Asian-American patient education initiative

PICOT component

Description

P- (Population)

Asian-Americans newly diagnosed for type 2 diabetes

I- (Intervention)

Implement patient-specific dietary and lifestyle changes

C- (Comparison)

Patients who did and did not receive effective nutritional education

O- (Outcome)

Reduction of A1C levels

T- (Time frame)

3 months after initial diagnosis

4. Rationale for selecting proposed solution.

Nurses have been serving in educator roles since the mid-19th century. For instance, May (2009) reports that by the mid-1800s, "Nurses taught family members proper sanitary precautions, disease prevention, and how to care for the sick" (p. 4). Since that time, this educator role has gained increasing importance since that time as professional nurses have become an integral part of a multidisciplinary health care team (May, 2009). In fact, nurses have been responsible for providing patient education concerning optimal dietary and lifestyle practices based on their patients' conditions and this practice has become part of nursing tradition today (May, 2009).

5. Evidence from your Review of Literature in Topic 2 to support your proposed solution and reason for change.

The need for improved management of newly diagnosed type 2 diabetes is great and this need will continue to increase well into the foreseeable future. At present, epidemiologists estimate that the number of individual diagnosed with diabetes will increase to 365 million worldwide by 2030, a figure that is double the existing number (Wu & Tun, 2014).

6. Description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)