OM 004 Walden University improving patient safety and quality of services paper 2
OM 004 Walden University improving patient safety and quality of services paper 2
The purpose of the quality improvement (QI) project was to examine the relationship
between amended nursing education concerning diabetes mellitus (DM) Type 2 self-care
management incorporating Tune in, Explore, Assist, Communicate, and Honor (TEACH)
and Motivational Interviewing (MI) strategies and techniques and the Glycosylated
hemoglobin (HgbA1C) of veteran patients with uncontrolled diabetes. The target sample
included the 2 licensed practical nurses and 2 registered nurses assigned to 2 primary care
teams, and the 10 purposively sampled patients with uncontrolled DM Type 2 from each
team. The nurses’ competencies were measured through descriptive comparison before
and after nursing education implementation using the instrument Patient Education:
TEACH for Success Self-Assessment Questionnaire. The nurses’ confidence and their
perceived importance of the TEACH and MI skills application and skill assessment for
promoting health behavior change were tested inferentially with a paired t test before and
after nursing education implementation using the instrument Clinician Importance and
Confidence Regarding Health Behavior Counseling Questionnaire. The primary care
team developed their skills tailored to each patient’s needs, considering the guiding
principles and premises of the health belief model (HBM). Patients’ self-care
management knowledge, skills and confidence were improved. The project decreased the
elevated HgbA1C of patients measured after the project initiative. The QI project leads to
positive social change by decreasing the number of patients with uncontrolled diabetes
among the veteran population. The patients and their providers can develop
individualized plans of care for diabetes management by educating, redirecting, and
evoking behavioral changes in the veteran patients by using a team approach.
Diabetes Mellitus Type 2: A Quality Improvement and Patient Safety Initiative
In the United States, diabetes mellitus (DM) Type 2 is considered a health care
dilemma, generating a massive national and global economic disparity. The Center for
Disease Control and Prevention (CDC, 2011) reported that the spread of DM is an
escalating predicament that involves approximately 25.6 million people in the United
States. According to the National Committee for Quality Assurance (2010), keeping
people healthy and developing new and more cost-effective interventions are needed to
tackle the burden of chronic illness. In this quality improvement project, I examined the
relationship between improved nursing education concerning DM Type 2 self-care
management and Glycosylated hemoglobin (HgbA1C) of uncontrolled diabetes at the
Southwest Veterans Affairs (VA) primary care clinic. The project will provide an
overview of the project, a review of the scholarly evidence, and the significance and
implications of the project. Section 1 of the paper will include a discussion of the
problem, its context and background, purpose statement, project objectives, the project’s
relevance to practice, the practice question to address, the project significance and
implications for social change, definition of terms, the project’s assumptions and
limitations, and summary.
Background/Context
To identify the prevention of a nationally significant disease, the impact of the
disease to the population of interest must be considered. The national health promotion
and disease prevention issue that I chose to address is patients over 18-years-old with
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diagnosed diabetes, whose HgbA1c value is >9%. The Healthy People 2020 listed this as
a leading health topic and indicator under clinical preventive services with current status
of little or no detectable change over the past 10 years (U.S. Department of Health and
Human Services, 2010).
The incidence of DM in the veteran population is multi-factorial and maybe
consequential from different system influences. The United States Department of
Veterans Affairs (2015) acknowledged the high prevalence of DM among the veterans,
which can be attributed to 25% of the population being overweight and another 40%
obese. Despite all of the programs and resources of the VA, patients with DM Type 2
who have an uncontrolled glycemic index are frequently seen throughout the six VA
primary care clinics of Las Vegas, where I serve as a nurse practitioner. The macro
system influences on the problem of uncontrolled DM Type 2 includes the absence of a
certified diabetes educator (CDE) and the compartmentalization of communication
between primary care and specialty care. The micro system influences on the problem of
uncontrolled DM Type2 include inconsistency in teaching; limited time to teach, educate,
and coach by providers; and inconsistent teaching materials not tailored to certain
populations and patient educational learning preferences. Other micro system influences
are teaching tools that are not patient-centered, patients’ fear of losing VA benefits,
patient’s learning preferences, and a lack of family support to control DM Type 2. These
factors contribute to the growing number of patients with uncontrolled DM Type 2;
therefore, there was a need to improve patient outcomes. To address the problems of DM,
the issues have to be tackled from the clinic level beginning with interventions from the
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nurses of the Patient Aligned Care Team (PACT), the basic unit of care at the VA
primary care clinics. The PACT nurses are the main contact for patients in each primary
care patient visit, where rapport and trust develops with each patient contact.
