Strategies To Reduce Chronic Disease: Adding Role To Community Health Workers, Ingrid J. Renwanz Dnp, Pmhfnp-Bc/Aprn, Msn, Rnc

Doctor of Nursing Practice (DNP) Projects

Background: Underserved, rural, immigrant, low-income Latinx communities need to strengthen healthcare access to improve their quality of life (Capitman et al., 2009; McCartney et al., 2019; Save the Children [STC] Organization, 2021). Non-communicable chronic disease of physical and behavioral origin is the leading cause of morbidity for adults and children in Latinx communities (Campbell et al., 2020). Estimates of greater than 30% of the Latinx populations within the United States have these health needs, with projections to reach 28% of the U.S. population by 2060 (Eghaneyan & Murphy, 2019; Ortega et al., 2018).

Local Problem: If poor access to preventive …

Enhancing Diabetic Patient Continuous Glucose Monitoring Access, Colleen Ildefonso

Master's Projects and Capstones

Problem: Diabetic patients utilize treatments that require frequent monitoring and medication changes based on their blood sugar results. Continuous Glucose Monitoring (CGM) is more commonly used for diabetes management as time in range is becoming more prevalent to measure diabetes outcomes. Many diabetic patients find CGM use more accessible than finger sticks and glucometers. In contrast, others utilize the technology to closely monitor their blood sugars for interventions throughout the day. However, older adults have difficulty facilitating new CGM technology and may require further reinforcement using additional education methods such as teach-back.

Context: The endocrinology clinic serves a patient population, …

Decreasing Surgical Complications In Diabetic Patients, Bandana Mahato

DNP Qualifying Manuscripts

Executive Summary

Objective: This manuscript aims to determine if controlling diabetes prior to undergoing low back surgery could decrease complications and disability.

Contexts: Despite the overwhelming information on the complications of uncontrolled diabetes, patients continue to have elevated HgA1C before having surgery. Furthermore, there is a plethora of data showing uncontrolled diabetic patients will have higher complications after surgery, yet patients continue to have elective surgery despite having unchecked diabetes. There are no clear guidelines for primary care providers or surgeons on when they should allow patients to have elective surgery. Therefore, it is vital that HgA1c needs to be …

Diabetes Prevention And Management Education For Punjabi-Sikh Older Adults, Mandeep K. Gill

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: South Asians from Bangladesh, Pakistan, and India have a higher prevalence of diabetes than the general global population and are also more susceptible to developing diabetes due to biological and lifestyle factors. The South Asian diet is high in refined grains and monounsaturated fatty acids, increasing the risk of diabetes.

Local Problem: Congregants of a Sikh gurdwara (place of worship) lacked knowledge of diet and lifestyle in relation to preventing and managing diabetes. Many senior congregants have been diagnosed with diabetes or are at high risk of developing the disease.

Methods: Knowledge of diabetes prevention and management were …

Continuous Glucose Monitoring And Diabetes Management During Pregnancy, Nicole Beamish

Doctor of Nursing Practice (DNP) Projects

Continuous Glucose Monitoring and Diabetes Management During Pregnancy

Abstract

According to the Scope of Practice, Standards of Practice, and the Standards of Professional Performance for Diabetes Educators, registered nurses play an integral role in the promotion of diabetes self-management education and training in diabetes care (AADE, 2017). This paper upholds the standards set forth by the American Association of Diabetes Educators (2017) governing body, to stimulate the process of peer review, promote documentation of the outcomes of diabetes self-management education and training (DSME/T), encourage research to validate practice and improve quality DSME/T and diabetes care for pregnant women who use …

Eliminating Barriers To Chinese American Diabetic Patients: Implementation Of Diabetic Cantonese Group Visits, Sabrina Wong

Doctor of Nursing Practice (DNP) Projects

Problems: Asian Americans have higher incidence and prevalence of diabetes mellitus type 2 and less preventive care and higher complication rates than the rest of the American population.

Context: According to the National Healthcare Quality and Disparities Reports (2016), Asian Americans are more likely to be diagnosed with diabetes compared to non-Hispanic whites by over ten percent.

Interventions: A comprehensive group visit program was implemented in a clinic in Oakland, Chinatown catered towards Cantonese-speaking diabetic patients. The group visit included culturally and linguistically appropriate materials related to nutrition, exercise, and diabetes knowledge. Each cohort attended a ninety-minute group visit session …

Type 2 Diabetes Mellitus In The Pediatric Population, Lorna Santiago

DNP Qualifying Manuscripts

The incidence and prevalence of diabetes in youth in the United States is increasing. In particular, type 2 diabetes mellitus (T2DM) is becoming more common in individuals younger than 20 years. Nurse practitioners and other primary care providers that see children should be knowledgeable about the condition and confident in participating in multidisciplinary management. Screening should begin at age 10 or at puberty, whichever comes first. Providers should screen all children who are overweight or obese or of Native American, African American, Latino, Asian American, or Pacific Islander race or ethnicity. Children of these ethnicities have a greater risk for …

Healthcare Provider Education: Adult Jamaicans With Type 2 Diabetes, Patricia Anderson

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Worldwide prevalence of type 2 diabetes mellitus (T2DM) among the Jamaican population is 11.9% (WHO, 2016). Jamaican patients and their families have experienced first-hand the debilitating complications of this deadly disease.

Context: Jamaicans with diabetes who live in the US experience these same complications. Approximately 300,000 Jamaicans live in Florida (Peart, 2020). This change of practice project was conducted with healthcare providers employed in a family medicine clinic in Florida that treat Jamaicans with T2DM.

Intervention: This change of practice project used an online evidence-based educational training (i.e., Jamaican culture, diet, and health beliefs and how to use …

Needs Assessment: A Food Pharmacy During The Covid-19 Pandemic, Genesis Talavera

Master's Projects and Capstones

Introduction

The needs assessment report discusses the effects of COVID-19 (Coronavirus) pandemic on a low-income Hispanic/Latino population specifically for diabetic patients seeking food pharmacy services at a non-profit clinic in San Mateo County. Nutrition is an essential aspect of diabetes management, which can be challenging to obtain among low-income populations. The COVID-19 pandemic has caused additional challenges among the general population, making it more challenging for the diabetic low-income population. This project was undertaken to identify the effects COVID-19 has on the food pharmacy patients.

Methods

The needs assessment consisted of eleven in-depth interviews done in six week period. A …

A Quality Improvement Project To Implement Shared Medical Appointments For The Management Of Type 2 Diabetes In Latino Patients, Denisse Maldonado

Doctor of Nursing Practice (DNP) Projects

Problem: Santa Rosa Community Health (SRCH) is one of the largest federally qualified health centers in Northern California, providing health care to more than 30,000 patients. More than half of the patients receiving care at the SRCH Lombardi site are Latino patients. Patients self-identify as Latino or other ethnicity on the initial health center registration form. SRCH serves 964 patients with diabetes. Due to limited access to appointments and resources, seeing a healthcare provider regularly can be difficult, posing a barrier to diabetes management. Patients with diabetes would greatly benefit from regular appointments with their primary care provider and resource …

Patient-Centered Education To Improve Health Outcomes Of Adult Jamaicans With Diabetes, Patricia Anderson

DNP Qualifying Manuscripts

There is a 42% prevalence of diabetes among Jamaicans (Ministry of Health, Jamaica Health and Lifestyle Survey, 2018). The survey found that Jamaicans will continue to face challenges of diabetes and its complication as approximately four out of ten Jamaicans are unaware that they have diabetes, and thus delay receiving healthcare.

Limited health literacy is predominant among the diabetic Jamaican population and negatively affects health outcomes (Singh & Aiken, 2017). Jamaicans were found to have poor knowledge of diabetes; in particular, they had difficulty identifying clinical signs of hyper/hypoglycemia, the importance of examining eyes and feet for abnormalities, normal fasting …

Obesity And Diabetes: Evaluating The Impact Of Promotores As A Prevention And Intervention Strategy In The Latino Community, Jessica Castaneda

Master's Projects and Capstones

This paper aims to examine obesity and diabetes among the Latino population as a health problem. As the largest minority racial group in the U.S, Latino rates of obesity and diabetes are greatly higher than whites. The prevalence of obesity in Latinos is 45% compared to that of whites at 34.5% (CDC, 2015). The disproportionate rates at which Latinos are affected by obesity and diabetes have prompted numerous programs to combat this health problem. Promotores or Latino community health workers have been able to provide the important piece of culturally and linguistically appropriate education for the population. Evidence shows Promotores …

Pursuing Equity In Diabetes Population, Aisha Rawlinson

Master's Projects and Capstones

Abstract

Background

Poor glycemic control (HbA1c >8) overtime leads to microvascular and macrovascular complications after the first and third years respectively, ultimately resulting in death after five years (Karter, 2016). Current Kaiser Permanente (KP) data stratified by race, ethnicity, age, and gender shows a significant disparity gap between Hispanics/Latino and Caucasian populations. The Pursuing IHI initiative is over a 2-year period completed at a microsystem that is focusing on health equity practices to reduce disparity gaps.

Project aim

KP Riverside, microsystem selected has a large population of Hispanic/Latino KP members, with focus on health equity. The project aim is to …

Reduced A1c Levels Through Diabetes Self-Management Strategies In The Teen Population: A Systematic Review, Nicole O'Neil

Master's Projects and Capstones

This project utilized current evidence-based practices to improve the diabetes education in the endocrine clinic for the adolescent population ages 15-18. Based on a clinic audit, an average hA1C level of 8.1% was revealed. The goal was to decrease these levels from 8.1% to 7.9% within 90 days through the implementation of the revised diabetes brochure. Evidence suggests the following: DSME improves clinical outcomes and quality of life; an A1C level >7% is associated with increased risks of complications ; teaching aimed at lowering glycemic levels have decreased numerous complications; there is a need to ensure age appropriate, family-centered care, …

Improving Management Of Inpatient Blood Glucose, Rachael K. Misitano

Master's Projects and Capstones

Epidemiologic studies indicate blood glucose management in the hospitalized patient population is not adequate; with approximately 30% of patients reporting values >180mg/dl. Patients with increased blood glucose levels pose a higher mortality risk as well as increased risks for dehydration, hypotension, renal injury, decreased wound healing, immunosuppression, and an overall increase in hospital length of stay (AACE, 2015). This project aims to improve inpatient management of blood glucose levels by facilitating MD-RN communication through a reduction in the current reportable blood glucose level. This project took place on a 17 bed adult medical-surgical unit at a large academic hospital in …

Postcolonialism And The Marshallese Diaspora: Structural Violence And Health In The Marshallese Community In Springdale, Arkansas, Alexander J. Hirata

Master's Theses

Despite moving to the United States for better healthcare, among other benefits, Marshallese Compact of Free Association (COFA) migrants residing in Springdale, Arkansas continue to face similar acute health problems as Marshallese living in the Republic of the Marshall Islands (RMI), and often without access to health services. These problems include high rates of noncommunicable diseases, such as type 2 diabetes and thyroid cancer, as well as rare conditions such as Hansen’s Disease.

To research this, I studied the limited texts surrounding the Marshallese diaspora, as well as relevant bodies of literature: postcolonialism, Pacific migration theory, and global health and …

Monitoring Non Compliant Diabetic A1c Levels, Laura J. Tracy

Master's Projects and Capstones

The AIM of this CNL project is to identify and connect with, those diabetic patients within the out-patient clinic that are not in compliance with their A1C laboratory values. Contacting these patients to schedule follow up and re-engagement in their health care plan, may improve their overall health care outcomes and decrease their risk of more frequent or prolonged hospitalization and increased use of medications. There are over 25.6 million adult diabetic people living in the United States as of 2010. The total cost of direct and indirect medical care is 174 billion dollars as of 2007. With over 3.9 …

In-Patient Self-Management Diabetes Education, Amy Matthews

Master's Projects and Capstones

The diabetes program strives to provide diabetes self-management education to the in-patient with diabetes. The specific aim is to improve and standardize diabetes education for the inpatient with diabetes by June 2015. The microsystem is a medical surgical unit for patients 18 years and older who present with diabetes as either a primary diagnosis or secondary diagnosis. Fifty percent of the diabetes patients on this unit are ages 65-89 years old, twenty nine percent are ages 50-64. The unit has 32 beds and is filled to capacity ninety five percent of the time. The fishbone diagram revealed our microsystem lacked …

Implementation Of Food Insecurity Screening In Clinical Setting, Florence Ngozi Soba

Doctor of Nursing Practice (DNP) Projects

This project used the Stetler model of research utilization framework to apply evidence-based findings to clinical settings screening adults with type II diabetes mellitus (T2DM) and low incomes for food insecurity. The project involved the review and critical appraisal of research studies and translation of research-based knowledge into a protocol for the Peach Tree Clinic with respect to the impact of food insecurity on diabetes outcomes in adults with T2DM and low incomes who were at risk of food insecurity. In addition, the proportion of screened at-risk patients who received nutritional counseling was calculated. The proportion of patients with T2DM …

Evidence-Based Change In Practice: Development And Implementation Of Type Ii Diabetic Flow Sheet, Kathryn Grimleybaker

Doctor of Nursing Practice (DNP) Projects

Ten percent of the National Health Service annual budget goes to treat complications from diabetes (Lancet, 2010). The American Diabetes Association® (ADA, 2013) estimated that diabetics in the United States incur $176 billion annually in direct medical costs for treatment with hospitalization being the main component of the expenditures. California has the largest population of diabetics and the highest annual cost at $27.6 billion (ADA, 2013). The Healthcare Cost and Utilization Project (HCUP, 2008) found that the average cost of hospitalization in 2008 for a patient with diabetes was $10,937 in contrast to $8,746 for a patient without diabetes. The …

Childhood Obesity Fieldwork Summary Report: The Food Education Project, Maria De Rosario Vasquez

Master's Projects and Capstones

Childhood Obesity and diabetes is on the rise and the health risk for developing various diseases is a major public health issue. This paper examines the public health issue on childhood obesity and diabetes. This paper explains the importance and magnitude of this problem by providing statistics, research efforts, educational efforts and the importance of preventing childhood obesity and diabetes. The paper will summarize, explain observations and provide insight on fieldwork completed through a project called The Food Education Project. The project focuses on addressing the major public health problem through educating children and adolescents on health, nutrition, food and …