Education at a community level

Running Head: DIABETES TYPE 2 1
Diabetes Type 2
Name of Student
Name of Professor
Institution Affiliation
Date

DIABETES TYPE 2 2
Task 1
Diabetes type 2 is a disorder in the metabolisms of blood glucose. It occurs as a
result of a failure of the body to respond appropriately to the endogenous insulin or as
a result of the production of inadequate insulin. This, therefore, leads to excess levels
of blood glucose in what is known as chronic hyperglycaemia. Diabetes brings about
complication such as nephropathy and neuropathy. Diabetes type two also results in
an increased risk of cardiovascular disease. Type 2 diabetes is one of the most
common chronic disease globally. In the year 2013, there were approximately 334
million people with diabetes globally, and this figure is expected to reach 350 million
by the year 2025. In New Zealand, it is estimated that approximately 200,000 people
have diabetes. There is also an increased prevalence of type two diabetes among
children below the age of 15 years. This essay discusses the effectiveness of patient
education in reducing the frequency of hospitalization due to complications brought
about by diabetes type two. The paper also reviews various articles to identify their
findings regarding the clinical issue and uses the findings of the articles to make
recommendations that can be implemented to improve the particular nursing issue of
concern.
During my clinical placement, I worked in a ward where diabetic type 2 patients
were placed. Most of the patients who were admitted to the facility were as a result of
complications in the cardiovascular system as well as respiratory diseases.
Approximately 42% of the patients at the hospital indicated that they smoke and they
take alcohol despite suffering from diabetes. An additional 12% of the patients
admitted at the facility were either overweight or obese. The patient history indicated
that 60% of the patients had been admitted at least once before due to complications
of type two diabetes. The patients also indicated that they had not received any

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education except for a few warnings from nurses when they visit the hospital. This,
therefore, is an indication that patients with type two diabetes are not getting
sufficient education which could help them to improve their health outcomes and
avoid hospitalization due to diabetes type two. This paper, therefore, seeks to
establish the effectiveness of patient education in reducing the prevalence of
hospitalization for diabetes type two patients.
The research question is an essential element of research because it focuses on the
issue being investigated and also the research process. PICO framework is very
effective in formatting a research question for evidence-based nursing studies. This
study uses the PICO framework to examine the effectiveness of systematic patient
education in reducing the prevalence of hospitalization resulting from complications
for diabetes type two patients.
P-Diabetes type two patients
I-Systematic health education
C-Not applicable
O-Reduction in the prevalence of hospitalization
The PICO research question therefore is; How effective is systematic patient
education in reducing the incidence of hospitalization for diabetes type two patients?
Task 2
A research article by Dulipsingh et al., (2016), indicates that nine studies
involving 998 respondents were conducted to establish the effectiveness of systematic
patients’ education in reducing the prevalence of hospitalization among diabetic
patients. The study was conducted in Nanjiang China, and it involved patients who
had completed enrollment and were randomized to systematic health education
model. The model was based on image education, visiting exhibition halls,

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dissemination of educational materials as well as individual medical nutrition therapy
and exercise programs. The study found out that systematic patient education is very
effective in reducing the prevalence of hospitalization for diabetes patients. According
to Rubin, (2015), patient education enables patients to be equipped with the
knowledge and skills required to manage the diabetes condition as well as make
necessary lifestyle adjustments to avoid complications of the disease. The author
indicates that educating patients resulted in a reduction in HbAlc by -0.67%. A
decrease in HbA1c results in reduction of microvascular and macrovascular
complications and hence reducing the prevalence of hospitalization.
The other article by Wong et al. (2016) conducted a study with 556 respondents
in Sidney, Australia. The study compared patients with diabetes who had undergone
systematic education with those who had not got any training. The study found out
that patients who had not undergone systematic education were three times more
likely to be hospitalized as compared to those with systematic diabetes education.
Patient education for a diabetic patient is associated with improved glycemic control
because they can control their diet and follow the recommended exercise routine
(Moslemirad, Madmoli, Madmoli & Niksefat, 2018). The study also found out that
systematic patients’ education results in sustained improvement in blood pressure and
metabolism of the patient and hence reducing the prevalence of hospitalization. The
article was selected from the Cochrane library, which is recognized for conducting
quality systematic reviews on evidence-based nursing. Both studies were carried out
using the method of randomized controlled trials, and hence the methodology used is
appropriate for this study.
One of the current best practice intervention in reducing prevalence in
hospitalization due to diabetes is sensitization through community-based clinics to

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educate people about diabetes (Krall et al., 2015). This could be effective in
transferring knowledge and skills to diabetes patients to help them adjust their
lifestyles to avoid complications associated with diabetes. Education at a community
level could be beneficial since it is easier to reach the target population. Education for
inpatient is not sufficient because of time and resource limitation and hence making it
challenging to offer effective patient education. The rationale for education
intervention is that diabetic is a condition which can be controlled if the patient
understands it well, and hence education can be very useful in helping diabetic
patients adjust their lifestyles to avoid the complications that might result to
hospitalization (Powers et al., 2017)
Generalizability of the study means that the recommendations of the two research
articles fit the specific condition or scenario being reviewed. The recommendations of
both articles can be generalized because the paper involves studies carried out in
Australia and China among diabetes patients. The effectiveness of systematic patient
education should, therefore, be similar in different countries since the survey focused
on the aspects of the presence of knowledge or lack of education and factors such as
age or gender were not considered. The recommendations of the articles are,
therefore, valid in answering the research question. The studies used electronic
databases such as MEDLINE, Biosis, AMED and EMBASE. The studies used
randomized controlled trials to examine the effectiveness of education in reducing the
prevalence of hospitalization among diabetic patients. The rigour of the researches is
also appropriate since the studies were analyzed and peer-reviewed and hence the
research process is of high integrity.
Part 3
Recommendations

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One of the recommendations I would make to improve the outcomes of a patient
with diabetes type 2 in order to avoid hospitalization is that specific training programs
should be organized in collaboration with community health workers. Forums
explicitly aimed at providing education to the patient with diabetes can significantly
help in transferring knowledge about the management of diabetes. Such conferences
should be organized regularly, for example, once every three months. The programs
should focus on patients who have diabetes as well as their families. According to
Kinney et al., (2015), patient education outside hospitalization is highly effective
since it helps the patients to avoid the complications and hence no need for
hospitalization.
Additionally, training offered outside the hospital setting can allow more
effective group education and cost-saving. According to Kummer, Recker & Bick,
(2017), patient education for groups helps patients to learn and retain more since they
can be able to share the best methods that they use to manage the disease. The
families of the patients can also attend the programs since they play a vital role in
helping the patient to manage the chronic illness. This, therefore, means that apart
from the nurses overseeing the education program, peer to peer learning can occur and
hence significantly help to reduce the prevalence of hospitalization related to diabetes
complications (Weng et al., 2015).
The other recommendation is the use of social media and technology to offer
education to diabetes type two patients. Social media has proved to be a very effective
intervention to deliver patient education. A review of twenty high-quality studies
comprising of three systematic reviews and 17 primary studies on the effectiveness of
social media as a channel of educating patients was done. Sixteen out of the 20 studies
indicated a significant reduction in HbA1c levels and hence a reduction in the

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prevalence of hospitalization (Peter et al., 2015). With the increasing popularity of
social media, nurses and clinicians should consider using social media to disseminate
education on diabetes. Marincic et al., (2017) indicate that the use of social media as a
tool for patient education is effective because it is more convenient. Hence, a patient
can get information at the comfort of their home.
Additionally, a patient can review the education materials from time to time in
case they have forgotten something or they need to ask something. The other
advantage of this intervention is that information in real-time, and it offers an
opportunity for immediate feedback. This method, therefore, could significantly
improve patient education since a person does not have to attend education forums
physically. The technique can also reach many people at the same time and hence
making it very suitable to educate diabetes patient and reduce the prevalence of
hospitalization.
Part 4
Leadership and management are very critical while introducing the
recommendations outlined above. The leadership of the facility determines whether or
not the recommendation will be adopted. To effect positive change in healthcare
organizations, it is important to have transformational leadership (Lee, Hong & Kim,
2016) The leadership of the healthcare organization should be ready and capable of
adopting and implementing changes in the physical environment as well as in the
policy to help improve health outcomes (Arnold & Boggs, 2019). The
recommendation on collaboration with community health workers to deliver patient
education can only be successfully implemented if the leadership is transformational
and is ready to adopt measures which have a positive change in improving the
delivery of healthcare services. The leadership should ensure that the

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recommendations are within the legal requirements since changes which are illegal
cannot be implemented. Additionally, the leadership of the healthcare organization
should adopt the proposal after evaluating the ethical implications of the
recommendation. If the recommendations are within the ethical boundaries of nursing,
the leadership must approve the recommendations to reduce the prevalence of the
hospitalization due to lack of sufficient patient education.
The management also has a significant impact on the implementation of the
recommendations. The management of the healthcare organization controls the
resources required to introduce the recommendations. Both recommendations require
an investment of both financial and human resources, but they have an impact on cost
reduction in the long run. The management of the healthcare organization should
exhibit professionalism when deciding on introducing the recommendations. Research
indicates that most errors or omissions made in primary care originate from decisions
made by the high-level management team. When making decisions regarding
healthcare, it is critical to make evidence-based decisions to avoid making decisions
based on emotions of initiation. Therefore, when introducing the recommendations,
the managers of the healthcare organization should search, appraise and apply
empirical evidence when making decisions such as adopting the recommendations
(De Almeida-Pititto et al., 2015).
The management is also vital since it determines how the recommended changes
will be implemented. The management should actively manage the difference if the
recommendations are to be introduced to the organization. This is because there is a
natural tendency to resist change among the employees. Therefore, the management
should actively oversee the introduction of the recommendations—the management
impacts on the introduction of the recommendations through ongoing communication.

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According to Davis et al. (2015), effective communication is an essential facilitator of
change in an organization. Hence, the level of communication from the management
will play an important role in the introduction of the recommendations.
Workplace culture is very critical when introducing changes to an organization.
Workplace culture represents shared values, ways of thinking and behaviour of people
working in the same healthcare organization (Ahmadi, Nilashi & Ibrahim, 2015). A
strong and positive workplace culture that emphasizes on professionalism and
adherence to ethics is likely to adopt the recommendations since they are backed by
empirical evidence, and they could bring a positive change to the organization and the
society (Zhang et al., 2015). A culture which is flexible and progressive will embrace
the recommendation on the use of social media as a tool for providing patient
education. The rate of technology adoption mainly depends on whether the culture of
the workplace is rigid or not. If the culture of the workplace is strict, both the
management and the other workers may resist the changes and hence making the
recommendations not work.
Part 4
Nursing research is the branch of nursing that is involved in carrying out research
to help patients receive optimal care and to contribute to medical advancements.
Nursing research includes different areas of the nursing field, which is very important
for the Registered Nurse (RN) who work directly with the patients.
It is very vital for a registered nurse to continually engage with nursing research
because it is only through research that the nurses will be able to adopt the evidence-
based practice in their work. Nursing research helps in carrying out studies on issues
affecting primary healthcare. The studies help in identifying weaknesses in the current
healthcare practices and make recommendations to help improve on areas where there

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are shortfalls (Schneider et al., 2016). Therefore, the decisions made by the registered
nurse in a clinical setting must be supported by the evidence collected through
research done by nurse researchers. This thus explains the importance of collaboration
between these two professions.
Engaging with nursing research helps in providing the nurses with the latest
information concerning changes in healthcare technology or new nursing
interventions which are more effective (Win, Hassa, Bonney & Iverson, 2015). The
healthcare profession is experiencing constant changes with the introduction of new
technologies, new interventions for providing care as well as changes in diseases. It is,
therefore, critical that registered nurses are up to date with any changes in the nursing
practice, which may help them to offer improved care to the patient. Adapting these
changes can help in improving patient outcomes and the level of care which is the
ultimate goal of nursing practice.
Another reason why engagement with nursing research is essential for registered
nurses is that it helps in improving clinical settings under which care is provided
(Shabibi et al., 2017). When nursing research carries studies and establishes that there
are ways in which patient care can be enhanced by improving clinical settings, they
make these recommendations which can then be adopted by RNs to improve the care
offered to patients.
Engaging with nursing research also helps in identifying highly effective methods
of providing patient education. Patient education is very critical in achieving excellent
health outcomes because it helps in preventing diseases. Patient education also allows
patients to manage chronic conditions and hence significantly to improve their health.
Therefore, nursing research is always on the lookout for new and effective measures
which can help in making patient education more effective to improve the care of the

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patients and to avoid illnesses. In addition to these, engagement helps in the
promotion of healthy work environments which helps in enhancing the productivity of
RN`s.

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