Managing Diabetes Type 2

Diabetes Type 2 Causes Patient Readmission

Researchers have established that the poor management of diabetes type 2 has caused an increase in the cost of managing the diseases, the number of diabetes 2 patients occupying health care facilities, and the frequency of readmitting the patients to the hospital after they have been diagnosed with the disease in the first visit. The prevalence rate of diabetes 2 patients among Americans has shown a significant increase between 2000 and 2010 and the trend has persistently remained positive (Healy, Black, Harris, Lorenz & Dungan, 2013). The problem is compounded by the delayed diagnosis of the disease, lack of appropriate education, training, and awareness on the best techniques to manage the diseases on the part of patients, nurses, and family members. The results have shown a high increase in readmission rates and the high cost of treating complications related to diabetes 2. According to Healy, Black, Harris, Lorenz, and Dungan (2013), complications associated with diabetes 2 include heart attacks, kidney disease, blindness, amputations, and depression (Kirkman et al., 2012). Statistical estimates show that 23 million Americans have been diagnosed with the disease and annual increases in readmission rates have been reported.

Research shows that the cost of taking care of diabetes 2 patients has increased four times compared to the cost of taking care of the patient with normal diseases, which has increased the burden on family members, healthcare facilities, and the government (Kirkman et al., 2012). A study by Kirkman et al. (2012) shows that people with diabetes 2 incur extra social service costs because they employ nurses to take care of them and doctors to address the complications associated with the disease (Kirkman et al., 2012). It has been established that one in five patients, who have not been taught how to manage the disease on their own, return to the hospital in a record 30 days after their initial visit. The main problem, according to Kirkman et al., (2012) is the failure to educate diabetes 2 patients on the most appropriate techniques for them to manage the disease to make their lives comfortable. Kirkman et al., (2012) argue that educating the patients on how to manage the disease will limit readmission cases, which are caused by recurring diabetes 2 complications.

According to Purdy (2010), the need to educate caregivers and especially nurses and doctors the underlying reasons causing diabetes 2 patients to seek readmission a few days after they have been discharged from the hospital and the monetary consequences of readmitting the patients is critical (Healy, Black, Harris, Lorenz & Dungan, 2013). Purdy (2010) argues that many patients and families with patients suffering from diabetes 2 have realized the need to create an education and awareness program to reduce the number of diabetes 2 readmission cases. According to Aalaa, Malazy, Sanjari, Peimani, and Mohajeri-Tehrani (2012), the cost of giving medical care and support to patients with diabetes 2 is straining the family resources, and leaving several families poor. A preliminary investigation by Purdy (2010) shows that unawareness on the part of patients and lack of well-organized schedules to visit their doctors has contributed to the problems (Kirkman et al.., 2012). In theory, awareness deals with a change in mind and the attitude a person develops towards an issue. On the other hand, training deals with empowering patients to be able to conduct self-monitoring of blood glucose to get specific information about their blood glucose (BG) levels (Purdy, 2010).

The Problem Is Significant In Several Ways

The cost of re-admitting diabetes 2 patients includes lost productivity and the actual cost of treating the patient, which is five times the cost of normal treatment. Kirkman et al., (2012), argue that readmitting patients to the hospital makes them incur huge hospital bills, which causes a negative financial and psychological impact on them and their families. Kirkman et al., (2012) have shown in their research that diabetes 2 costs are usually associated with the treatment of complications. Many families assign a significant percentage of the family budget for the treatment of their family members. An analysis of the cost distribution of medical care for diabetes 2 patients shows that money is incurred in culture and sensitivity analysis and in purchasing the antibiotics used to treat complications caused by the disease. If the total dose per day of treating a patient with antibiotics is calculated for the whole year, the cost becomes prohibitive for the family and the healthcare givers to afford. Some costs are incurred because of surgical intervention if a patient suffers from severe complications, which is aside from the cost associated with wound dressing and other minor complications (Kirkman et al., 2012).

Kirkman et al., (2012) argue that the high number of readmission rates reduces the capacity of healthcare facilities that could be preserved for other deserving causes. A study by Kirkman et al., (2012) shows that a higher percentage of diabetes 2 patients get admitted and occupy hospital facilities compared with patients with other types of diseases. According to Kirkman et al., (2012), admission data for patients with diabetes 2 and other types of diseases in a New York hospital in 2010 established that more than half of the patients admitted to the emergency division of the hospital (80%) were diabetes 2 patients. In the same hospital, 60% of the patients who were admitted to the hospital were diabetes 2 patients, and more than half of the people were seeking readmission. It has been established that the number of diabetes 2 patients seeking readmission has been increasing over the years, causing an alarm over the large increases in readmission rates (Pandya & Nathanson, 2009).

An analysis of the data on the number of diabetes 2 patients readmitted between 2008 and 2013 based on a survey conducted by the New York state health foundation shows a positive trend in the number of cases registered for readmission. The results show that patients with diabetes 2 had a readmission rate of 20.6%, which was far lower than the percentage of patients readmitted at the same time in the same hospital with other types of diseases (Pandya & Nathanson, 2009). It has been estimated that people with diabetes 2 incur twofold the cost of inpatient treatment when readmitted and the hospitals incur more than 40.8% direct costs of readmitting diabetes 2 patients. The actual cost incurred by hospitals for readmitting diabetes 2 patients is 39.8% (Pandya & Nathanson, 2009). According to Kirkman et al. (2012), increasing the medical costs for patient and family members in the form of hospital bills indicate that many nursing professionals and home caregivers are not playing their roles well. Nurses play a significant role in training patients because of their knowledge in foot anatomy, walking dynamics, weight-bearing abilities, and vulnerability levels of diabetes 2 patients. Nurses should teach patients how to comply with healthcare requirements and encourage them on how to monitor the progress of the disease to detect earlier signs of complications to keep healthy.

The Problem Is Appropriate To Nursing And The Student

Pandya and Nathanson (2009) argue that nursing professionals have a role to play to ensure that patients are offered high-quality nursing care that results in improved patient outcomes. If there are high numbers of readmitted diabetic patients in a health facility, then this could imply that nurses are not offering quality care (Kirkman et al., 2012). One of the roles of a nurse is to decipher the reason that makes diabetic patients be readmitted. An understanding of the reasons could enable nursing professionals to implement interventional strategies that could reduce the negative impact associated with re-hospitalization. Students in the nursing field are nursing leaders of tomorrow. The problem becomes significant for students because they need to acquire knowledge about the causes of readmission of diabetic patients. This would adequately prepare them to participate better in bigger projects in the nursing field in the future (Silow-Carroll, Edwards & Lasjbrook, 2011).

The Context Of The Problem

According to Benbow (2009) diabetes type 2 disease affects persons from all cultures across the world. Research has shown that the number of diabetes 2 cases has been increasing drastically in the world (Benbow, 2009). The disease is presenting a serious public health problem throughout the world and the generation of people in their 30s living with the disease is increasing drastically. Some of the factors which contribute to the prevalence rate of diabetes 2 among young people and adults are their poor nutritional lifestyles. However, it affects more adults than children, but the number of young adults suffering from the disease has increased in the recent past. Socioeconomically, research has demonstrated that persons at high socioeconomic levels have more chances of developing the disease than those at low socioeconomic levels. This could be explained by the types of lifestyles that groups at different socioeconomic levels adopt. Patients with adequate education adopt better ways of managing the disease than those with limited education (Benbow, 2009). The environment could influence the onset of the disease in many persons. For example, some environmental factors such as terrain limit the movements of persons and make people develop the disease because of limited body exercise.

Intervention, Implementation, And Evaluation

Intervention: The intervention will focus on the use of education, awareness, and home care to improve the management of diabetes type 2 in patients.

Education And Awareness

Healy, Black, Harris, Lorenz, and Dungan (2013) argue that different societies have embraced the importance of education and awareness campaigns for patients with diabetes 2 chronic conditions. Martin and Lipman (2013) argue that using education and awareness programs consists of implementing structured programs with the necessary publicity to keep patients from being readmitted by delaying the development of diabetes 2 and its complications. Martin and Lipman (2013) argue that education and awareness help patients manage their health conditions without readmission to the health facilities. By integrating inpatient diabetes control and management programs into the education and awareness programs, patients will be taught how to administer self-medication, eat the right foods, and perform self-care activities. Qualified family members and nurses could train patients on how to monitor the progress and development of diabetes 2 by testing for retinopathy, nephropathy in urine, and by frequently seeing an ophthalmologist for further consultations. Education, training, and awareness could empower every diabetes 2 patient to live comfortably in their lives (Stone &Hoffman, 2010). The intervention strategy could reduce the number of patients readmitted after their first visit to the healthcare facility.

According to Martin and Lipman (2013), well-trained nurses working on evidence-based practice can use published meta-analysis and systematic reviews of evidence tables to gain the competencies and skills required to intervene and educate diabetes 2 patients on how to manage the disease to reduce or avoid being readmitted to hospitals (Stone &Hoffman, 2010). The theoretical basis of the arguments on education, training, and awareness program is to change the behavior of diabetes 2 patients by imparting in them the right skills and knowledge to use (Kirkman, Briscoe, Clark, Florez, Haas, Halter, Huang, Korytkowski, Munshi, Odegard, Pratley & Swift, 2012). Appropriate theories and curriculum on the training and awareness framework underpin the program for educating diabetes 2 patients to change their behavior to manage their conditions and avoid being re-hospitalized after their first visit to the health facility. Kirkman, et al., (2012) proposed the adult learning theory as the most appropriate vehicle for delivering instructions to the patient. The goal of the adult learning theory and the psychology of behavior change is to provide a framework to educate patients to change their behavior, habits, and to develop generalized guidelines on how to manage diabetes 2 conditions through constant and accurate self-monitoring of glucose, which is an evidence-based practice widely recommended for use (Kirkman, et al., 2012). The adult learning theory enables nurses and family members to facilitate the learning process on the importance of creating a positive non-judgmental attitude by the patient and optimizing the outcomes for diabetes 2 patients. Implementing the Goal learning theory becomes effective if based on an appropriate self-care model.

One of the models that have been proved effective is Orem’s self-care model. The model provides nurses with a comprehensive base for nursing best practices and can be applied to ensure that patients are taught how to use universal self-care requisites, health deviation self-care requisites, and therapeutic demand self-care requisites to be able to perform self-care activities without the support of other people (Healy, Black, Harris, Lorenz & Dungan, 2013). It has been established that interactions between diabetic patients on a continuous basis motivate them to support each other to work for their good (Hines, Yu & Randall, 2010). The strategy is to teach patients how to interact continuously based on Rodgers’ theory of unitary human beings, where human beings are regarded as one and not dichotomous. The theory provides the basis for understanding the basic characteristics of pan dimensionality, patterns of interactions, and openness in human beings (Purdy, 2010).

The theory could enable diabetic patients to interact continuously with the environment and accept changes that could be beyond their control. In practice, the proposed education, training, and awareness program will function on a health care systems model, which factors cost, control, access, and quality factors for diabetes patients. It will enable nurses and trained family members to organize and manage the awareness program effectively for the benefit of diabetes 2 patients and family members (Purdy, 2010). The model underpins the process of imparting patients with the knowledge on strengthening their defense and resistance to environmental factors that could cause complications (Pandya & Nathanson, 2009). The models and theories discussed above will be complemented using Watson’s caring theory to offer education and awareness to patients in such a way that to allows for the intervention to be planned, assessed, and evaluated effectively. Watson’s theory, based on the seven principles, provide a framework for caring for diabetes 2 patients to promote individual and family growth, which is based on maintaining the health of the patient instead of curing the patient to avoid readmitting them to the hospital again (Healy, Black, Harris, Lorenz & Dungan, 2013). The theory aims at promoting health and caring for the sick, which is a practice that is central to nursing. The education and awareness interventional strategy involves family members and nurses. The approach is important because they would offer care to diabetic patients when they are too weak to manage themselves (Pandya & Nathanson, 2009).

Home Care

According to Pandya and Nathanson (2009), the proposed solution is to reduce the rate of patient readmission and the cost incurred by family members and healthcare facilities by employing qualified nurses and trained family members to implement education and awareness programs on how to control blood sugar levels in diabetes 2 patients. The interventional strategy is to take a balanced diet, weight reduction, and body exercises (Pandya & Nathanson, 2009). If those measures result in poor outcomes, patients are offered oral or intravenous medications under the home care program (Pandya & Nathanson, 2009). Home care involves monitoring and timely visits (every three months) to assess patients’ conditions. Apart from nurses, other healthcare providers such as medical officers and clinical officers have to participate in offering home care services. Research has established that holistic participation and continued home care nursing empowers and motivates patients to live healthier lives and significantly reduces the chances of re-hospitalization if the diabetic patients embrace the best health practices (Pandya & Nathanson, 2009).

Implementation And Evaluation

The intervention was executed for a period of one year in selected locations. The locations were identified on the basis of documented cases of diabetes type 2 and the number of hospital readmissions because of diabetes 2 cases and related complications. The success of the intervention was determined through the evaluation of the initiative. The evaluation was to seek to identify the strong and weak points of the intervention, which involved teaching diabetic patients on self-care best practices (Hines & Randall, 2010; Silow-Carroll, Edwards & Lasjbrook, 2011; Stone & Hoffman, 2010). A comparison was made between the expected and achieved outcomes. For example, the number of readmissions before and after the execution was recorded. According to the findings, it was established that the number of complications because of diabetes type 2 before and after the intervention reduced significantly (Silow-Carroll et al., 2011). A study of the data made available from one of the healthcare facilities between 2008 and 2010 showed that the discharge rate of diabetes 2 was 9%. The research was conducted with a population of 2265 diabetes 2 patients before and after the interventional strategy of the awareness program was implemented. Individualized teaching was conducted using materials for home use, which covered various issues of diabetes 2 management techniques.

Family members assisted with the teaching and observations and an analysis of the outcome data was done after 30 days of the first visit. It was established after the period that 33% of the participants who were under the education program were readmitted compared with 45% who did not receive any training or awareness on diabetes self-care management strategies. A decrease in the number of readmissions and complications after the implementation of the intervention program indicated that the intervention program was a success. Reasoned argument showed that if the number of complications and cases readmitted was higher than the number of cases not seeking readmission after the program was implemented, it could imply failure of the initiative (Silow-Carroll et al., 2011). The decision made was to continue with the intervention on the premises of evaluating the evaluation results to decide on the best strategy to adopt (Healy, Black, Harris, Lorenz, & Dungan, 2013). It was further established that hospital readmission was an important factor contributing to the high cost of taking care of diabetes 2 patients. If specialized focus and emphasis were placed on home and self-care plans for the patients, the risk of readmission because of complications could drop significantly. The results of the study showed the need for diabetes 2 patients, nurses, and family members to embrace the home self-care education and awareness program to help patients live conformably and avoid being readmitted after their first visit to the hospital.

References

Aalaa, M., Malazy, T., Sanjari, M., Peimani, M. & Mohajeri-Tehrani, M. (2012). Nurses’ role in a diabetic foot prevention and care; review. Journal of Diabetes & Metabolic Disorders, 11(24), 2-6.

Benbow, D. (2009). Heart Failure: Educating your patient can help prevent readmission. Nursing Management, 40(9), 5-7.

Healy, S., Black, D., Harris, C., Lorenz, A., & Dungan, K. (2013). Inpatient Diabetes Education Is Associated With Less Frequent Hospital Readmission Among Patients With Poor Glycemic Control. Diabetes Care, 1(1), 1-8.

Hines, P., Yu, K., & Randall, M. (2010). Preventing Heart Failure Readmissions: Is Your Organization Prepared? Nursing Economics, 28(2), 74-85.

Kirkman, S., Briscoe, V., Clark, N., Florez, H., Haas, L., Halter, J., Huang, E., Korytkowski, M., Munshi, M., Odegard, P., Pratley, R., & Swift, C. (2012). Diabetes in Older Adults: A Consensus Report. Journal of the American Geriatrics Society, 10(1), 1-15.

Martin, A., & Lipman, R. (2013). The Future of Diabetes Education: Expanded Opportunities and Roles for Diabetes Educators. The Diabetes Educator, 39(1), 436-446.

Pandya, N., & Nathanson, E. (2009). Managing Diabetes in Long-Term Care Facilities: Benefits of Switching from Human Insulin to Insulin Analogs. American Medical Directors Association, 10(1), 1-8.

Purdy, S. (2010). Avoiding Hospital Admissions: What does the research evidence say? The Kings Fund, 1(1), 1-28.

Silow-Carroll, S., Edwards, J., & Lasjbrook, A. (2011). Reducing Hospital Readmissions: Lessons from Top-Performing Hospitals. The Commonwealth Fund, 5(1), 1-19.

Stone, J., & Hoffman, G. (2010). Medicare Hospital Readmissions: Issues, Policy Options and PPACA. Congressional Research Service, 7(1), 1-37.

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