The Brady Health Center is a neighborhood medical facility that serves a large population of African Americans and Latino Americans. The Diabetic Clinic center serves 2679 patients of which 80% are Blacks. The Hospital Management has noted a low adherence rate to diabetes self-care recommendations among the African American population. As a result, I, the nurse manager, the hospital administration and staff members are planning to implement a Diabetes Self-Management Education (DSME) program in collaboration with the American Diabetes Association that aims at improving patient knowledge and self-care skills.
Change Theory
As the modification manager, I intend to utilize Lippitt’s change theory in the implementation of the DSME initiative. According to Lippitt’s theory, the first phase of reform implementation involves the diagnosis of the problem (Mitchell, 2013). Following a survey that was carried out at Brody health center among diabetes clinic attendees, one of the most significant contributors to poor outcomes among Blacks was the lack of knowledge on the disease process and its complications. The second and third steps involve the assessment of the capacity for change and the evaluation of the resources needed as well as the motivation level of the change implementers. The fourth stage requires the formulation of change objectives followed by role assignment to change agents. The sixth step is characterized by the integrating and maintaining change so that it becomes part of the system. The last step involves the evaluation of the change process.
Other change theories that would also assist me in the implementation of the program include the Lewin and Kotter models. The Lewin theory has three stages namely Unfreezing, moving, and refreezing steps. In summary, the model emphasizes the initiation, motivation and maintenance of change (Antwi & Kale, 2014; Mitchell, 2013). The Kotter’s approach puts an emphasis on collaboration, vision development, communication, empowerment of change agents, and integration of the modifications into the organization culture (Antwi & Kale, 2014).
The Implementation Process
This process will begin with a training and education forum for internal stakeholders (physicians, nurses, and other caregivers working in the diabetes clinic) (Mitchell, 2013). The training conference will focus on the need for patient education for effective diabetes self-management. It will equip the trainees with the diabetes information that they are to pass on to the patient. The session will also emphasize on cultural awareness and sensitivity issues that are associated with dealing with a predominantly African-American population. Care providers need to be aware and sensitive to socio-economic and cultural dietary barriers to diabetes self-care (Vorderstrasse, n.d). The American Diabetes Association will provide the posters, pamphlets, and PowerPoint presentations required for this forums.
Following the training, we will introduce a DSME program for patients that will be held on a weekly basis. The patients attending the clinic will be notified of the initiative via text messages, posters, social media, and the mass media. At the beginning of the program, the attendees will fill in a pre-test questionnaire that will assess their knowledge of diabetes and its management. The education forum will focus on self-care skills, diet, physical activity, and adherence to the treatment protocol. Each weekly session will last for about two hours. Attendees will fill in a post-test form after every session. The program will also make use of the patient portal in the Hospital Information Management System (HIMS) to give individualized dietary and lifestyle recommendations. Care providers will use text messaging to encourage patients to assess their glucose level and enter their daily values into their records via the patient portal. Patients’ hbA1c levels will be determined at the beginning of the initiative and every three months after that.
The implementation of this initiative will require human resources (doctors, nurses, nutritionists, and other medical staff), pamphlets, computer tablets, posters, pre-test and post-test forms, and handouts. The participants will require access to a Smartphone with the HIMS and glucose buddy applications.
Program Goals
The DSME initiative goal is to enhance self-care knowledge and skills among diabetes patients with an aim of helping them in stabilizing their blood glucose level, preventing diabetes complications, and improving their quality of life. The programs goals are as follows:
The assessment of the program’s success will involve the measurement of outcome variables such as blood glucose levels, HbA1c, diabetes knowledge, the incidence of diabetes complications. We expect to see positive changes in HbA1c and blood sugar levels within a period of six months to one year (Khunti, 2012). A decrease in the rate of diabetes complication is anticipated at the end of twelve months. Each session of DSME is expected to increase the self-care knowledge and skills of each participant significantly.
The success of the program was dependent on effective leadership, collaboration, and communication among change implementers. As a leader, my role was to bring internal and external shareholders together to develop a vision and strategy as a team as well as ensure that the resources required for the initiative were available. The active participation and availability of the nurse manager and other hospital leaders assisted in keeping the staff members motivated. Open communication channels among stakeholders, the hospital management, and staff members via meeting, progress reports, and emails helped in coordination and the resolution of emerging issues during the implementation phase (Mitchell, 2013).
References
Antwi, M. & Kale, M. (2014). Change management in healthcare. Kingston, Ontario: The Monieson Center for Business Reseach in Healthcare
Khunti, K., Gray, L. J., Skinner, T., Carey, M. E., Realf, K., Dallosso, H., & Davies, M. J. (2012). Effectiveness of a diabetes education and self-management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three-year follow-up of a cluster randomised controlled trial in primary care. BMJ 2012;344:e2333
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management Vol 20 (1): 32-37
Vorderstrasse, A. A. (n.d) Cultural Issues in Diabetes. Retrieved Jul. 28, 2016, from http://nurse-practitioners-and-physician-assistants.advanceweb.com/Continuing-Education/CE-Articles/Cultural-Issues-in-Diabetes.aspx
