Evidence-Based Practice Proposal Section A: Organizational Culture and Readiness Assessment

Evidence-Based Practice Proposal Section A: Organizational Culture and Readiness Assessment

Evidence-Based Practice Proposal

Section A: Organizational Culture and Readiness Assessment

The “organization Culture and Readiness for System-Wide Integration of Evidence-Based Practice” is the organizational culture survey tool that was utilized during the assessment. This tool has been shown to be effective in assessing and determining the organizational readiness to adopt evidence-based practice (EBP) (Yoo et al., 2019).

The survey findings show that the organization is ready to participate and adopt the evidence-based practice. Nurses at the Managed Care organization are knowledgeable about EPB and are adequately equipped with EBP skills. The management and leadership in the organization are supportive of EBP and provide the necessary resources and finances to support EBP projects. The survey also identified that there are nurse scientists in the organization who generate evidence and actively search and locate research evidence. There are nurse practitioners who mentor nurses about EBP and support the implementation of EBP projects. There is the availability of computers, electronic devices, and the internet where the staff can effectively search for evidence to support EBP.

However, the survey identified barriers to EBP where some staff members were not ready to embrace changes and innovations due to time limitations and busy schedules. The staff members were generally resistant to changes. The resistance is attributable to heavy workload and thus the staff may lack time to participate in EBP projects. This barrier can be addressed by using change champions to educate the staff members about the importance of EBP changes. Secondly, the organizational leadership should consider recruiting more staff members to reduce the workload among the staff. (Harper et al, 2017) Evidence-Based Practice Proposal Section A: Organizational Culture and Readiness Assessment.

References

Harper M, Gallagher-Ford L, Warren J, Troseth M, Sinnott L &Thomas B. (2017). Evidence-Based Practice and U.S. Healthcare Outcomes.
Journal for Nurses in Professional Development
. 33(4), 170-179.

Yoo, J. Y., Kim, J. H., Kim, J. S., Kim, H. L., & Ki, J. S. (2019). Clinical nurses’ beliefs, knowledge, organizational readiness, and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture.
PloS one
,
14
(12), e0226742.
https://doi.org/10.1371/journal.pone.0226742

Section B: Proposal/Problem Statement and Literature Review

Proposal/Problem Statement

Diabetes is the leading cause of adult-onset blindness, chronic kidney disease, and the amputation of lower limbs. The condition is also associated with increased risk of stroke and heart disease and evidence indicates that diabetes is the 7
th
leading cause of death within the US (Yeoh et al., 2018). Moreover, diabetes is associated with high healthcare costs (about $327 billion annually), and financial burden is projected to increase exponentially with the increase of the aging population and increased life expectancy (Yeoh et al., 2018).

The geriatric population with type 1 diabetes (TID) keeps on rising, and predisposes older adults to hypoglycemia, especially when diabetes is long-lasting. Hypoglycemia is associated with aspects such as altered mental status, loss of consciousness, and seizures, which can be fatal (Yeoh et al., 2018). However, the problem of older adults with TID has not been adequately addressed. Lowering hypoglycemia is a vital component of the management of TID in the geriatric population because the majority of older adults have difficulties in identifying and recognizing symptoms and signs of hypoglycemia or cognitive impairment. Evidence shows that older adults using continuous glucose monitoring (CGM) devices can reduce the rate of hemoglobin A1c and thus reduce the rate of hypoglycemia and severe hypoglycemic incidents. Therefore, the proposed study aims to find out if the utilization of CGM can lower hypoglycemia in older adults with TID. The CGM device continuously measures the level of blood glucose and provides real-time values of the blood sugar levels, trends direction, and notifies the patients when the glucose level increases to high levels or drops to low levels (Yeoh et al., 2018).

Literature Review

According to Litchman & Allen (2017), people with TID are living longer and thus there is a high number of older adults with the condition. The risk of fatal or severe hypoglycemia allied to taking insulin rises with age and thus older adults are likely to experience incidents of fatal or severe hypoglycemia. This is supported by Janapala et al (2019) who explain that the risk of hypoglycemia significantly increases among the older adults because of decreased awareness to recognize warning signs of hypoglycemia, decreased counterregulatory response, as well as altered psychomotor performance. A study carried out by Azhar et al (2020) demonstrated that type 1 diabetes in the geriatric population increases the risk of cerebrovascular and cardiovascular events, falls, hospitalization, seizures, and visits to the emergency department. It is challenging to diagnose hypoglycemic events in older adults who are mostly not aware of their hypoglycemia and can fail to be detected by the self-monitored blood glucose (SMBG) measurements.

In spite of the high risk of hypoglycemia and other complications for older adults with T1D, few studies have tackled the use of technologies in the geriatric population. This can be attributed to the mistaken belief that the geriatric population lacks the knowhow to handle the advanced technologies. However, some studies have shown that CGM improves glycemic control and safety in older adults with T1D (Ruedy et al., 2017).

The benefits of CGM in people with T1D have been demonstrated in several studies, in comparison to the routine glucose testing. Therefore, CGM is now an important tool for the management of T1D. However, Ruedy et al (2017) explain that the use of CGM in T1D is limited and the associate benefits of CGM have not been established. The management of diabetes in the geriatric population is also a challenge due to the polypharmacy and the multiple comorbidities in this population. Therefore, CGM equips individuals with diabetes with the ability to personalize diabetes management. Moreover, even though evidence shows that lowering HbA1c to <7% through comprehensive glycemic control reduces the risk of complications such as microvascular complications; this is associated with an elevated risk of hypoglycemia (Chehregosha et al., 2019). Since the continuous glucose monitoring devices are equipped with features like hypoglycemia alarms and trends, and also because the CGM devices are very accurate, CGMs can effectively lower the risk of severe hypoglycemic incidents among the older adults (Azhar et al., 2020). References Azhar, A., Gillani, S. W., Mohiuddin, G., & Majeed, R. A. (2020). A systematic review of the clinical implication of continuous glucose monitoring in diabetes management. Journal of Pharmacy and Bioallied Sciences , 12 (2), 102. Chehregosha, H., Khamseh, M. E., Malek, M., Hosseinpanah, F., & Ismail-Beigi, F. (2019). A View Beyond HbA1c: Role of Continuous Glucose Monitoring. Diabetes therapy: research, treatment, and education of diabetes and related disorders , 10 (3), 853–863. https://doi.org/10.1007/s13300-019-0619-1 Janapala, R. N., Jayaraj, J. S., Fathima, N., Kashif, T., Usman, N., Dasari, A., Jahan, N., & Sachmechi, I. (2019). Continuous Glucose Monitoring Versus Self-monitoring of Blood Glucose in Type 2 Diabetes Mellitus: A Systematic Review with Meta-analysis. Cureus , 11 (9), e5634. https://doi.org/10.7759/cureus.5634. Litchman, M. L., & Allen, N. A. (2017). Real-time continuous glucose monitoring facilitates feelings of safety in older adults with type 1 diabetes: a qualitative study. Journal of diabetes science and technology , 11 (5), 988-995. Ruedy, K. J., Parkin, C. G., Riddlesworth, T. D., & Graham, C. (2017). Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND trial. Journal of Diabetes Science and Technology , 11 (6), 1138-1146. Yeoh, E., Lim, B. K., Fun, S., Tong, J., Yeoh, L. Y., Sum, C. F., … & Lim, S. C. (2018). Efficacy of self‐monitoring of blood glucose versus retrospective continuous glucose monitoring in improving glycaemic control in diabetic kidney disease patients. Nephrology , 23 (3), 264-268. Evidence-Based Practice Proposal Section A: Organizational Culture and Readiness Assessment