Peer response

• How do you anticipate integrating this role into your current or future career?

As a DNP-prepared nurse, I hope to be employed in an educational role. I would love to teach graduate-level nurses. Closer to retirement, I plan on conducting and assisting in research projects. DNP scholars and leaders are able to integrate nursing theory and scientific principles from the social sciences to guide nursing practice for the complex patient and family conditions in a variety of settings (Sherrod and Goda, 2016).

• Compare faculty DNP-prepared nurse educator activities to the activities of the clinical DNP-prepared nurse educator in a healthcare organization or to mentoring or education activities of the DNP-prepared healthcare systems leader.

DNP academic nurse educators develop skills and should be very competent in teaching, research, communication, and ethics (Mikkonen et al., 2018; Ziatanovic et al., 2017). The DNP-prepared nurse educator can bridge the nursing faculty shortage, all while bridging the gap between service and practice that is lacking in todays healthcare (Meonna-Quinn and Genova, 2019). The DNP nurse educator and the academic nurse educator are both qualified to improve quality and services and standardize practices that increase quality outcomes.

Part II: For Case Study Students

• Practice Question in PICOT Format

For adult patients with type 2 diabetes at a primary care clinic, will the implementation of a Diabetes Self-Management Education and Support (DSMES)  Program, compared to current practice, impact fasting blood sugar and self-management in 8-10 weeks?

Use the bullet points as headings.

• What creative solutions can address the barriers and/or optimize the facilitators? You are receiving push-back and resistance from the frontline staff.  Share briefly what you hear from the front lines of nurses as they are doing their best to cope with the current pandemic or another environmental event. How can you lead nurses to cope with these changes?

As the magnitude of diabetes continues to rise and create a burden on the healthcare system, vital solutions are imperative to address this national practice problem. Implementation of the diabetic self-education management program plays a vital role in empowering patients to accept self-management activities. The acknowledgment of barriers such as fear of the unknown, inadequate family support, intentional nonadherence, lack of motivation and exercise, poor socioeconomic status, low-income level, misinformation of the peers, and poor perception of nutritional therapy is essential to decrease the burden of diabetes places on the healthcare system (Han et al., 2017; Mogre et al., 2019; Onwudiwe et al., 2017). Diabetic instruction is feasible via word of mouth by healthcare professionals (registered nurses, dieticians, physicians), peer-led groups, Weblogs, web-based media, and telephone conferences/calls with healthcare professionals (Rasoul et al., 2019; Shen et al., 2017; Wu et al., 2013).

Awareness and acknowledgment, combined with general, individualized education on disease management, consequences, risk reduction, lifestyle, and nutritional changes are key factors in reducing the prevalence of the practice problem (Mogre et al., 2019; Onwudiwe et al., 2011). Onwudiwe et al. (2011) and Kayyali et al. (2019) both note that limited health education and literacy from health care providers and peers were substantial in comparison to Vitger et al. (2017) who reported that the internet was the first or second preference if the information was needed.

Currently, I work at an urgent care. When COVID initially started, there was an influx of patients that wanted testing and treatment. Due to the increased patient volume, there was not enough time for adequate care. Time, limited resources, and being short-staffed have been the biggest complaint

• You are continuing to conduct your formative evaluation for intervention fidelity and provide feedback. What are you learning about project implementation?

Project implementation must have effective and clear communication. Strong communication skills enable you to better interact with patients and teammates and are essential for improved healthcare outcomes. Listening skills with receptive body language is equally as important to patients and colleagues.

• Are there reminders or practice prompts you can develop and provide at this time to support intervention fidelity? If so, what are the reminders or practice prompts and how do you believe they can help?

Intervention fidelity is the continual assessment and monitoring of the reliability and validity of your study. Strategies that would ensure intervention fidelity would be to standardize the training that is given to my colleagues. Participant evaluation of the understanding of the information and the ability to utilize the skills that are taught during the DMSE sessions would also ensure fidelity.  

• In your simulated case study project, are you able to collect the data you need? If not, what are the barriers, and what do you need to do to ensure that you will have the data to evaluate the success of the project implementation? Can the data be more easily documented and/or obtained?

Yes, data will be collected in patients logbooks during the DSME sessions. Data will include weekly weights and fasting blood glucose levels. Barriers that I perceive to happen will be patients not keeping up with their logbooks or a delay in the documentation. To combat this, I could offer weekly callbacks to patients to ensure that they are documenting in their logbooks daily to present at the next session.

References:

Han, L., Ma, Y., Wei, S., Tian, J., Yang, X., Shen, X., Zhang, J., & Shi, Y. (2017). Are home visits an effective method for diabetes management? a quantitative systematic review and meta-analysis. Journal of Diabetes Investigation, 8(5), 701708.

Kayyali, R., Slater, N., Sahi, A., Mepani, D., Lalji, K., & Abdallah, A. (2019). Type 2 Diabetes: how informed are the general public? A cross-sectional study investigating disease awareness and barriers to communicating knowledge in high-risk populations in London. BMC public health, 19(1), 138. https://doi.org/10.1186/s12889-019-6460-7

Menonna-Quinn, D., & Genova, T. T. (2019). The DNP-prepared nurse as an educator. Fast Facts for DNP Role Development. https://doi.org/10.1891/9780826136855.0007 

Mikkonen, K., Ojala, T., Sjgren, T., Piirainen, A., Koskinen, C., Koskinen, M., Koivula, M., Sormunen, M., Saaranen, T., Salminen, L., Koskimki, M., Ruotsalainen, H., Lhteenmki, M. L., Wallin, O., Mki-Hakola, H., & Kriinen, M. (2018). Competence areas of health science teachersA systematic review of quantitative studies. Nurse Education Today, 70, 7786. 

Mogre, V., Johnson, N. A., Tzelepis, F., & Paul, C. (2019). Barriers to diabetic selfcare: A qualitative study of patients and healthcare providers perspectives. Journal of Clinical Nursing, 28(11-12), 22962308.

Onwudiwe, N. C., Mullins, C. D., Winston, R. A., Shaya, F. T., Pradel, F. G., Larid, A., & Saunders, E. (2011). Barriers to self-management of diabetes: A qualitative study among low-income minority diabetics. Ethnicity & Disease, 21, 2732.

Rasoul, A. M., Jalali, R., Abdi, A., Salari, N., Rahimi, M., & Mohammadi, M. (2019). The effect of self-management education through weblogs on the quality of life of diabetic patients. BMC Medical Informatics and Decision Making,19(1). doi:10.1186/s12911-019-0941-6

Shen, H., Wang, Y., & Edwards, H. (2017). Can a community-based peer-led diabetic self-management program be effective: 12-week evaluation. Journal of Clinical Nursing,26(11-12), 1621-1631. doi:10.1111/jocn.13526

Wu, S. F., Liang, S. Y., Lee, M. C., Yu, N. C., & Kao, M. J. (2014). The efficacy of a self-management program for people with diabetes, after a special training program for healthcare workers in Taiwan: a quasi-experimental design. Journal of clinical nursing, 23(17-18), 25152523. https://doi.org/10.1111/jocn.12440

Zlatanovic, T., Havnes, A., Mausethagen, S. (2017). A research review of nurse teachers competencies. Vocations and Learning, 10, 201233.