Interventions and Outcomes Measurement for the Elderly with Diabetes
In my practice as an advanced practice nurse, the elderly populations who in addition to their advanced age have diabetes as a chronic condition were determined to be a high-risk population. The determination of this status was on the basis of several attributes, one of them being the competing needs. The fact that some of the members of this population are economically dependent on their family members requires them to prioritize their needs. The presence of the chronic disease condition also classifies them as a high-risk population. In addition to this, other factors such as poor health seeking behaviors, low education levels, inadequate or lack of medical cover, and the low social, economic status predicts their classification as a high-risk population group.
Kirkman et al., (2012) offer a rationale for the development of interventions for this population. The scholars argue that one of the most significant predictors of the diabetes epidemic is the aging of the population. The determination of the impact of diabetes is based on the adults of the working age. However, the attributes highlighted above, particularly their economic dependence on the working family members necessitates the implementation of interventions to help improve their health. Additionally, Kirkman et al., (2012) find that the fact that diabetes in this population leads to impaired functional status, increased mortality, and a higher likelihood of institutionalization warrants the development of evidence-based interventions to improve their health.
The implementation of the interventions is best accompanied by the evaluation of outcomes to determine whether there are any improvements in the health of the target population. These sentiments are echoed by Fineout-Overholt, Gallagher-Ford, Mazurek & Stillwe (2011) who argue that one of the elements of evidence-based plans is the evaluation of the outcomes. In addition to the measurement of the health of the population, the evaluation of the interventions will also help determine their effectiveness (Potter, Perry, Stockert & Hall, 2016).
Evidence-based Interventions for the Elderly with Diabetes
There are various evidence-based interventions that can be implemented to help improve the health of the elderly population with diabetes as a chronic condition. The evidence-based interventions for this population are based on the management of blood glucose levels and the prevention of complications that arise as a result of diabetes (Tulchinsky & Varavikova, 2014). One of the evidence-based interventions for the target population is the capacity building of the members of the population for self-care. The choice of this intervention is supported by evidence. Shrivastava, Shrivastava & Ramasamy (2013) argue that the needs of people diagnosed with diabetes go beyond the control of their blood sugar. They also incorporate preventing the onset of the complications that result from diabetes.
Self-care plays a significant role in helping prevent the occurrence of these complications. The intervention entails teaching the patients self-care behaviors such as compliance with the medicine give, making good food choices, the application of healthy coping strategies, engaging in physical activity, and monitoring one’s sugar level. Shrivastava et al., (2013) argue that teaching the elderly patients with diabetes the ideals of self-care has been shown to improve the glycemic control and the reduction in the likelihood of the onset of complications.
Shrivastava et al., (2013) also shows that self-care has been shown to lead to a higher quality of life for the elderly. The choice of the intervention is also reiterated by Ginn (2014) who argues that the daily problem solving that characterizes diabetes management can pose challenges for the patients. Self-care allows them to improve their outcomes by preparing them to care for themselves even when they do not have the help of their family members. This is a significant factor especially considering the constraint identified earlier to the effect that the elderly population with diabetes might not have the family members to provide care.
The other intervention entails education on foot care to reduce the likelihood of the lack lower limb dexterity and amputations. The choice of this intervention is in response to the prevalence of complications in diabetes. Litwak et al., (2013) argues that the increase in the prevalence of the complications affects the health outcomes of the patients. For instance, Lopez (2015) argues that 5% of patients diagnosed with diabetes develop foot complications such as ulcers that result in amputation for 1% of this population.
It follows that education on foot care can help them reduce the likelihood of the occurrence of foot problems which can lead to amputation. The choice of this intervention is also supported by the findings of a multidisciplinary expert panel tasked with the development of an education framework to be used in the management of patients who have a diminished likelihood of the onset of foot complications (Mclnnes et al., 2011). The panel reported health behaviors required of the patients with a reduced likelihood of developing complications. These behaviors include yearly foot screening and examinations, daily foot care, glycemic control, and health reporting (Mclnnes et al., 2011).
Outcome Measurements for the Evaluation Phase
The evaluation of the project entails the measurement of the outcomes that result from the implementation of the evidence-based interventions. The first intervention was the capacity building for self-care among the elderly population with diabetes as a chronic condition. The measurement of the outcomes of the assessment of this intervention will focus on the self-care competence (Marques, Josefina da Silva, Coutinho & Lopes, 2013). Marques et al., (2013) argue that the assessment should measure the percentage of the population that has developed the competence for self-care following the implementation of the intervention. It is expected that 60% of the population who comprise the recipients of the intervention will show competence for self-care. The assessment of the second intervention will entail the measurement of the increase in knowledge regarding foot care among the elderly population with diabetes. The outcome measurement will compare the baseline results with the results of the outcome evaluation to determine whether learning took place.
Reflection
The development of the intervention program has far-reaching implications for my practice as an advanced nurse practitioner. The implementation of this project will help improve my competencies in the care and management of the elderly population with diabetes. Interdisciplinary collaboration is required for the implementation of this project. This is one of the essentials for a doctorate in advanced nursing practice. The implementation of the project in collaboration with other healthcare team members will prepare me for other similar projects. The use evidence-based interventions enable the patients to participate in their care. Expectedly, the patient outcomes for my unit will improve because of the increased capacity of the patients to influence their health.
References
Fineout-Overholt, E., Gallagher-Ford, L., Mazurek, M. and Stillwe, S. (2011). Evidence-Based Practice, Step by Step: Evaluating and Disseminating the Impact of an Evidence-Based Intervention: Show and Tell. American Journal or Nursing. 11(7): 56-59.
Ginn, A. (2014). Diabetes self-management improves outcomes. Today’s Geriatric Medicine. 7(4): 24.
Kirkman, S., Briscoe, V., Clark, N., Florez, H., Baas, L., Halter, J., Huang, E., Korytkowski, M., Munshi, M., Odegard, P., Pratley, R., and Swift, C. (2012). Diabetes in older adults. Diabetes Care, 35(12): 2650-2664.
Litwak, L., Goh, S., Husseing, Z., Malek. R., Prusty, V. and Khamseh, M. (2013). Prevalence of diabetes complications in people with type 2 diabetes mellitus and its association with baseline characteristics in the multinational Achieve study, Diabetology and Metabolic Syndrome, 5:57
Lopez, V. (2015). Diabetic ulcers. Retrieved from http://emedicine.medscape.com/article/460282-overview
Marques, M., Josefina da Silva, M., Coutinho, J. and Lopes, M. (2013). Assessment of self-care competence of elderly people with diabetes. Revista da Escola de Enfermagem da USP, 47(2), 415-420.
Mclnnes, A., Jeffcoate, W., Vileikyte, L., Game, F., Lucas, K., Higson, N., Stuart, L., Church, A., Scanlan, J. and Anders, J. (2011). Foot care education in patients with diabetes at low risk of complications: a consensus statement. Diabetic Medicine, 28(2): 162-167.
Potter, P., Perry, A., Stockert, P. and Hall, A. (2016). Fundamentals of nursing. New York. Elsevier Health Sciences.
Shrivastava, S., Shrivastava, P., and Ramasamy J. (2013). Role of self-care in management of diabetes mellitus. Journal of Diabetes and Metabolic Disorders. 12: 14.
Tulchinsky, T. H., & Varavikova, E. (2014). The new public health. Amsterdam. Academic Press.
