Evidence-Based Nursing Practice in Diabetes Care

This assignment delves into the crucial role of evidence-based nursing practice in managing diabetes. It examines various aspects, including effective patient education strategies, the importance of clear communication between nurses and patients, and the collaborative nature of diabetes care involving healthcare teams. The assignment emphasizes the application of current research findings to enhance patient outcomes and promote holistic diabetes management.

Running head: Healthcare Nursing Assignment
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HEALTHCARE NURSING ASSIGNMENT
-Importance of Training Nurses to Educate Diabetes Type 2 Patients
Name of the Student
Name of the University
Author Note

1Healthcare Nursing Assignment
Introduction:
The article discusses the importance of increasing the comfort level of nurses in their
ability to teach patients who have been discharged from the care facility, so that they are able
to care for themselves better. This outcome has been identified through a PICO analysis;
there the selected population included type two diabetes patients, recently discharged from
acute care. The selected intervention was training of the nurses on how to educate patients
on their diet, exercise routine, medication, insulin therapy and regular checkups.
Comparison of the selected population was done with patients who have not been educated
by the nurses or those who are not following the recommended practices in diabetes control.
The goal and plan of the article is to discuss how the comfort of the nurses can be improved
so that they are able to adequately educate their patients, which can be evidenced by the
patient’s ability to identify and manage their conditions and prevent any secondary
complications.
Coppola (2015) suggested that Therapeutic Patient Education (TPE) can play a
vital role in the treatment and management of diabetes. This is supported by several trials that
show patient education to cause improvement in clinical, lifestyle and psycho-social
outcomes of the patients with type 2 diabetes. TPE are designed to educate the patients in self
management and adapting to or coping with their treatment regimen. This is important for
self management and to maintain the quality of the long term care and avoid complications.
The aim is to produce a therapeutic effect that is additional to the other treatments (like
pharmacological and medical) (euro.who.int, 2018)
Pros and Cons of Evidence Based Practice:
Several benefits have been associated with Evidence Based Practice that can facilitate
improvement in the quality of care, foster professional development and leadership as well as

2Healthcare Nursing Assignment
improve clinical competence and build influence. These aspects have been discussed below
in details. However, Rosenberg and Donald (1995) pointed out certain drawbacks of evidence
based practice. Firstly, EVP takes a long time to learn, practice and develop mastery over.
This is a significant constraint in busy healthcare setups where time is a luxury most
healthcare personnel can’t afford. Secondly, the infrastructure needed for implementing EBP
requires extensive monetary investment, as it entails purchase and maintenance of different
information technology hardware and applications to support EVP. Thirdly, EVP can cause
frustrations among practitioners, especially the young and inexperienced ones, since gaps in
knowledge are highlighted by the process. Fourthly, screening the litrerature to identify the
relevant one can also be very challenging, and if not indexed propely can be nightmarish for
the researcher. Finally, EVP can challenge the authority of senior clinicians and healthcare
professionals, as it can lead to identification of gaps in their knowledge, and can highlight the
necessity for them to use newer strategies for care. Professionals who are already set in their
practice can find adapting to the new system to be very challenging.
Few other challenges of EVP include, the unavailability of the ‘best available
evidence’ for a particular scenario (like novel techniques or technologies), the requirement of
the professionals to be always up to date and have necessary skills for searching and
analyzing evidence, and the outlook of the management to use EBP to reduce staffing
expense, and hire inexperienced professionals (cebma.org, 2018).
However, despite these disadvantages, EVP provides several advantages which have
been discussed below:
Discussion:
1. Application of evidence-based research:

3Healthcare Nursing Assignment
Type 2 diabetes is caused when the cells of the body stops responding or shows a reduced
responsiveness insulin hormone. This condition is also known as insulin resistance. Due to
this resistance, the pancreas starts producing excess insulin to remove the excess glucose in
the blood. However, due to prolonged resistance, the insulin is unable to sufficiently control
the blood glucose level, due to which it rises. A state of pre-diabetes occurs before diabetes
type 2 sets in. Evidence of diabetes can be found through a blood test (Cdc.gov, 2018).
The importance of evidence based research (EBR) or Evidence Based Practice (EBP)
in healthcare and nursing has been implicated by several authors. Ellis (2016) pointed out that
evidence based approach enables access, critique and application of information uncovered
through researches into practice. Therefore, nurses should embrace all opportunities for
lifelong learning, so that specific skills can be developed in the identification and analysis of
evidences, which can foster growth in the career. LoBiondo-Wood (2017) also supported
this view, with the opinion that nursing practice is always challenged with the requirement to
constantly expand the ‘comfort zone’ of the nurses through the development of new
approaches to health issues, old or new, and designing innovative strategies or
interventions for healthcare. Through evidence based practice, nurses should be able to
collect, evaluate and integrate evidences from researches, combine them with their clinical
expertise, and understanding of the patient to make clinical decision for the patient.
Furthermore EBP can improve patient safety, clinical outcomes, and also decrease
healthcare cost and fluctuation in the health outcomes (Black et al., 2015).
Different barriers (individual and organizational) that prevent proper utilization of
research data by nurses have been identified by the studies by Black et al. (2015). The
individual barriers include: knowledge gaps in research and critique process, lack of
awareness of studies or researches, unsporting co-workers and a perception of the lack of
authority to implement a change in clinical practice, and implementation of EBP.

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Organizational barriers can include: shortage of time, accessibility to research information
and research tools. Furthermore, providence of support, research mentors or educators can
facilitate the utilization of researches.
Studies from across the globe also highlight similar challenges and facilitators to EBP.
Studies in Oman by Ammouri et al. (2014) suggested that continued education and
minimizing the barriers are vital to allow the implementation of EBP in clinical care.
Furthermore, increased involvement in EBP also has shown to foster a positive attitude
towards it, and helps to reduce the challenges. Norwegian studies by Stokke et al. (2014)
showed that the knowledge of the nurses as well as their participation in EBP facilitates its
implementation. This highlights the necessity of the nurses to maintain sufficient and up to
date knowledge on clinical practices and research studies and methods. The importance of
research training to clinicians or nurses, in the implementation of EBP was suggested by
Black et al. (2015).
The learning objectives focusing on evidence based research can help to reduce the
knowledge gaps, improve awareness of research and critique methods for evaluation of
information and therefore help to increase participation, improve confidence of the nurses
and foster a positive outlook towards EBP. Studies by Varaei et al. (2013) also support
similar views. It can also be understood, that more knowledge possessed by the nurses can
ensure better education being given to the patients.
2. Quality improvement approach using reference outcome:
Improvement in the quality of the education given to the patients can be attained
through an increased understanding of deferent aspects of the disease or dysfunction. Such
aspects can include the pathophysiology, aetiology, treatment, management and prevention,
as well as pharmacological aspects (Benner, 2012). Fumić, Marinović, Braian (2014)

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supported the idea that through continuous education, the quality of healthcare can be
improved. Batalden and Davidoff (2017) suggested that efforts that can improve patient
outcomes, system performance and professional development can improve the quality of the
care. Also, both Moor’s and Miller’s model keeps knowledge as an important step towards
clinical performance or competence (nursecredentialing.org, 2014). Continuous education has
been considered to have positive effects on patient outcomes and improve their executive
performance, as well as lead to professional development.
The American Diabetes Association recommends the following strategies for improving care
for diabetes patients:
 Setting up a communication that is patient centered, and keeps the preference of
the patient into account. Also assessment of literacy and numeracy and
addressing of any cultural barriers is important.
 Evidence based guidelines should be used for clinical decisions and treatment,
and should take into account the preference as well as the co morbidities and
prognosis.
 Components of the Chronic Care Model should be used to align the care with.
This can help to ensure a positive communication between the provider and
patient.
 Utilizing care based on support team, community support and involvement,
patient registries and tools for decision support whenever possible to provide care
for the patients.
(diabetesjournals.org, 2016)
Additionally, three themes that can enable positive outcomes have been identified by
American Diabetes Association as: Patient Centeredness, Support throughout life and

6Healthcare Nursing Assignment
advocacy for diabetic patients (diabetesjournals.org, 2016). These onions highlight the
necessity of communication and education in the improvement in the quality of care. Based
on this overview the learning objectives that can improve the quality of care can include the
following outcomes:
Educating patients so that they can fully comprehend the progress of the disease, its
risks, co morbidities, and management and prevention strategies can help them make
better health choices. This will be evidenced by the ability of the patient to comprehend fully
these factors. Moreover, the patient should also be aware of the associated diseases that can
occur due to diabetes type 2.
A. Certain aspects that can be included in the patient education program includes: Risk
factors (like high body mass index, no physical activity, family history and race/
ethnicity), prevention strategies (healthy weight, regular exercise and healthy diet)
(Shcc.ufl.edu, 2018).
B. Training nurses on the discharge instructions for type two diabetes. The awareness
and understanding of the discharge instructions, which includes educating the patient
about situations where they might need to call emergency or 911; medication to be
followed (like insulin or hypoglycemic medicine, blood pressure medication, and
platelets); monitoring blood glucose level (and actions to be taken if it is too low),
checking feet for sores, how to maintain healthy weight, healthy meal plan and
nutritional chart, exercise routine, checking blood pressure, and regular follow-
ups with physicians (Drugs.com, 2018).
3. Team building and working with an interdisciplinary team:
Team can be of various types based on its members, like i) teams within a single
professional domain ii) multidisciplinary team iii) team working in one geographic location

7Healthcare Nursing Assignment
iv)team distributed geographically v)team with fixed membership and vi)team with
fluctuating membership (Who.int, 2018).
Teamwork is essential to ensure treatment, safety and care for the patient. Better the
teamwork better can be the providence of care and the performance of the team. Teamwork is
important as it allows a collective to seek for the same goal, communication is fostered by
teamwork, which in turn reduces medical errors and maintains a positive work
environment (Landman, Aannestad, Smoldt & Cortese, 2014). The importance of teamwork
is further highlighted by the increasing complexity and specialization required in healthcare,
thereby giving rise to the need of the healthcare professionals to learn and use new
techniques, methods or equipments. The multidisciplinary approach is even more crucial in
cases of chronic diseases like diabetes, cardiopulmonary disease or cancer
(Hrhresourcecenter.org, 2018).
Specific learning objectives and learning outcomes have been identified by the World
Health Organization, related to team work in healthcare. The learning objectives include:
 Developing knowledge of the vitality of teamwork in healthcare.
 Understanding how to be an efficient team player
 Being ready to be participate in several teams for healthcare
The learning outcome like knowledge and performance can be considered to be
effective plan for this study. Knowledge wise, the nurses should have an understanding of the
different teams involved in the care for diabetes patients (like nutritionist, social care
workers, community workers, and podiatrist, physician and physical fitness professionals).
Additionally, they should know about the functions and characteristics of each of them, and
the importance of patient in the team (Who.int, 2018).

8Healthcare Nursing Assignment
Working with nutritionist allows the development and maintenance of healthy diet by
the patient. The importance of healthy diet, balanced nutrition and lifestyle changes in the
prevention and management of diabetes have been studied extensively. Healthy diet choices
includes whole grains, vegetables, fruits, legumes, and reduction in the consumption of
refined grains, red meat, processed meat, and sugar sweetened beverages (Ley, Hamdy,
Mohan & Hu, 2014). Studies by Hu, Satija and Manson (2015) also highlight the necessity of
healthy food and nutrition and physical activity in diabetes prevention.
Working with social support workers allows the continuation of care outside the
medical facility. The American Diabetes Association recommends that Chronic Medical care
should include support to change patient behavior. This can be provided through Diabetes
Self Management Education (DSME) and Diabetes Self Management Support (DSMS) and
can improve self management, patient satisfaction and blood glucose level (American
Diabetes Association, 2018)
Working with Podiatrist to ensure regular checkups and management or treatment for foot
ulcer, a common associated risk for diabetes. The importance of podiatrist and dieticians in
the primary care of patients has also been suggested by Seidu et al., (2017). Similarly,
community and social care workers can help to improve knowledge, lifestyle and health
behavior, and health outcome related to type diabetes type 2 (Alaofè et al., 2017)
4. Patient safety and quality improvement:
Improvement of safety and quality of care outcomes for the patient can be attained
through the understanding of complications (like hypo and hyper glycemia) associated with
diabetes.

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Diabetes type is associated with several different complications. According to NHS, if
diabetes is left untreated or unmanaged, can lead to other health issues like cardiovascular
disease and stroke (increasing likelihood of arthrosclerosis and angina), nerve damage
(causing peripheral neuropathy), diabetic retinopathy (by damaging the blood vessels of the
retina), kidney dysfunction (blocking the blood vessels of kidney, disrupting their function),
foot problems (like foot ulcer), sexual dysfunction (due to reduced libido, vaginal dryness or
pain during intercourse) and even miscarriage or stillbirth (in case of high blood glucose
during pregnancy) (nhs.uk, 2018). Complications related to Glycemic variation have been
studied by Hirsch (2015). The study showed that the fluctuations in the blood glucose levels,
called the glycemic variation (GV) can lead to the pathogenesis of vascular diseases or
complications due to poor macrovascular outcomes. The studies further showed association
of association of hypoglycemia with poor macrovascular outcomes, cause both micro and
macrovascular end points and increased risk of death after a cardiovascular event. This places
both hypoglycaemia and hyperglycemia as risk factors for vascular complications. Studies by
Ismail et al., (2017) have also suggested the possibility of depressive symptoms being
associated with type 2 diabetes. Furthermore the studies also showed a correlation between
depressive symptoms and macrovascular dysfunctions. Association of foot ulcers with
diabetes have been studied by Yazdanpanah, Nasiri and Adarvishi (2015), that showed
Diabetic Foot Ulcer (DFU) as one of the most common complication related to diabetes, and
it generally fails to heal, and can even lead to amputation of lower limb.
This shows why it is vital that the patients understand about the risk factors and
complications related to diabetes, so that they are able to make informed health decisions to
treat or manage their condition. Training nurses on effective ways to explain such factors to
the patient can be a helpful way to reach such objective.

10Healthcare Nursing Assignment
Beeney (2015) pointed out the absence of adequate information provided by the
healthcare professional about the diabetes, to the patients. Due to this they increasingly turn
towards mass media, which can give distorted or confusing information. This emphasizes the
importance of properly educating the patient about its complications and risk factors.
Diabetes Self Management Education (DSME) also should address the health beliefs of the
patient, the cultural needs, current knowledge, emotional needs, physical capabilities, family
support, medical history, financial status, numeracy, health literacy and other factors that can
allow patient and caregivers to meet the requirements of self management of diabetes
(Powers et al., 2015).
5. Leadership and communication:
In healthcare environment, leaders must show flexibility, vision, motivation,
attention, and communication skills, to create a culture of safety (Achonline.org, 2018).
Al-Sawai (2013) noted different type of leadership that can be utilized by healthcare
professionals, like transformational leadership, collaborative leadership, conflict
management, shared leadership, and distributed leadership, ethical leadership and
functional result oriented leadership. Hargett et al. (2017) suggested that shared leadership
can enhance learning, teaching, and patient care outcomes. Shared leadership can be
developed through effective collaboration and delegation of tasks and foster shared
governance, continuous learning and workplace relationships (Al-Sawai, 2013). A key action
in leadership is the ability to articulate vision to physicians, nurses, care staff and other
professionals in healthcare. Proper articulation of vision ensures alignment to the goals and
guidelines of the organization and industry (Butler, 2013). Therefore communication can be
understood as a key aspect of leadership.

11Healthcare Nursing Assignment
Riley (2015) points out those communication skills are necessary for nurses to be able
to fully participate with the healthcare team. Communication allows the coordination of the
care. Kourkouta and Papathanasiou (2014) suggested that good communication with patients
is necessary to ensure positive outcomes in the care of patients, and nurses should be able to
understand and help patients, showing courtesy, kindness and sincerity. They should also
provide adequate time in the conversations, ensuring confidentiality. Important principles of
communications includes maintaining bi directional nature of conversation, ensuring the
intended meaning of the information is clear, using non-verbal communication, listening
skills and developing good personal relationship. Furthermore, patients should feel
comfortable with the nurses, and also ensure no misunderstandings arise in the
communication. Ensuring a peaceful and confidential environment can foster serious
communications with the patient. However, the nurses should maintain frankness and
honesty in their thought and opinions (Kourkouta & Papathanasiou, 2014).
Teaching nurses about the importance of building rapport with the patients can help
to improve their confidence levels, as well as establish communication. The nurses should be
able to educate newly diagnosed patients for diabetes proactively and effectively. To ensure
that the nurses are able to follow effective techniques to educate the patients, and to inspect
the quality of the education given, huddles can be held at the start of the shift or during
change of shift. Furthermore emphasis should be laid on the ability of the nurses to take
charge of the teaching process. Positive effects of educational programs on communication
competency to nurses have been studied by Doherty et al. (2016).
Bello (2017) discussed the Peplau theory of interpersonal relationships that
consists of five overlapping phases: orientation phase, identification phase, exploitation
phase, resolution phase and termination phase. In the orientation phase, the therapeutic
relation between the nurse and patient is initiated. This is marked by the introduction or

12Healthcare Nursing Assignment
greeting with the patient. Since the focus of the conversation is the patient, their concerns
should be properly and carefully listened to. In the identification phase, the health issue is
identified, and intervention or treatment plans are designed. In the exploitation phase, the
nurse assists the patients how to use health services, as well as perform re assessment, re
evaluation and re interventions whenever necessary. In the resolution phase decisions about
ending the therapeutic relation ensues while in the termination phase, the therapeutic
relation is terminated.
6. Power and influence to leading change:
Learning objectives that can utilize power and influence in order to lead a change
can be effective strategies for development. For example, teaching the support care
workers and ancillary staff about the things that they should report about diabetes patients
that can identify opportunities to educate the patients. For example identification of lifestyle
risks for diabetes like sedentary lifestyle, lack of exercise, unhealthy diet, consumption of
sugar sweetened beverages, lack of sleep or unusual sleeping habits and smoking. Educating
patients on the risks of such habits can help them to make better lifestyle choices.
The power to influence changes in healthcare can be outlined by the following
objectives:
 The ability to demonstrate how personal power can influence change
 Recognition and validation of the power of the nurses to cause transformation
 Ensuring motivation and confidence to the nurses to embrace the power and
initiate transformation in healthcare.
Power can be understood as the ability of a person to influence the behavior of others
or to act or create an effect. Power also requires exercise of command and influences others

13Healthcare Nursing Assignment
without exertion of force, and a sense of self efficacy. Contingencies of power lie in
substitutability, interdependence between team members, discretion, judgment, visibility,
clarity and mentoring. The power can be sourced through various methods: legitimate
power (through formal authority), reward power (controlling the reward allocation and
removing negative sanctions), coercive power (application of punitive measurements),
expert power (through the possession of knowledge and expertise in subject matter) and
referent power (through the reference by others) (Nursinglibrary.org, 2018). Such attributes
can be utilized to lead a change in the healthcare practice to ensure the providence of
effective and continued care for the patient.
An effective partnership of the nurses with physicians and other healthcare
professionals is a necessary component to allow transformation of healthcare in the United
States (ncbi.nlm.nih.gov, 2018). This is based on the results of the Gallup Poll that shows
that doctors and nurses were rates as first and second best sources of health information by
opinion leaders. The poll also pleased nursing profession as the most ethical profession,
while healthcare providers were rated high on honesty and ethics (Nurse.org, 2018). This
highlights the trust inherent in the profession, and the responsibility to ensure the trust is
maintained and respected. Ensuring safe, ethical and effective care for the patient can help to
preserve this trust.
Conclusion:
Considering the importance of knowledge possessed by the patients in the ability to
actively take care of them after hospital discharge, and the importance of educating diabetes
patients, especially those who have been recently diagnosed with the disease can improve the
health outcomes and prevent the risks of complications. Furthermore by increasing the
comfort level of the nurses to provide proper education to the patients will ensure they are

14Healthcare Nursing Assignment
able to take healthy life decisions. Patient education is especially importance in case of
lifelong conditions like diabetes or cancer, and patient education strategies like TPE and
Diabetes Self Management Education have shown positive results in terms of patient
healthcare and satisfaction outcomes. To ensure proper education to patients and adhere to
the best clinical practice, implementation of evidence based practice is a crucial component.
It allows the ability of the nurses to critically evaluate current scientific evidence, and make
clinical decisions based on the best evidence. It also leads to continuous education and
professional development of the nurses and thus improves their competence. Quality of care
can also be improved through evidenced based practices that educate the nurses about the
various aspects of the disease, its management and prevention. Quality improvement through
effective communication and coordination between healthcare teams has been highlighted by
many studies. Additionally, the providence of proper care is supposed to be centered on the
patient, providing support life long, and promote advocacy for diabetes patients. Nurses
should show confidence in working with different healthcare teams, being able to coordinate
their efforts, and engage in effective communication, that is centered on the well being of the
patient. Building effective teamwork can also reduce medical errors, and improve healthcare
results. Also, effective communication can help to develop leadership skills, and an ability to
influence people to create a positive change in the industry. Effective training of nurse
should include the development plan for each of these attributes, in order to empower the
nurses to improve the healthcare industry of today. The high level of trust attributed to
nursing and healthcare professionals incorporates the responsibility to maintain this trust, and
ensure the well being of the patients.

15Healthcare Nursing Assignment
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