Self Management Of Diabetes Among African American Health Plan Paper Rough draft for health plan topic: Health plan for self management of diabetes among A

Self Management Of Diabetes Among African American Health Plan Paper Rough draft for health plan topic: Health plan for self management of diabetes among African American. Topic: Health plan for self management of diabetes among African American.
Submit a draft of your health plan (see the final health plan instructions for an outline of what should be
included in the plan).
Define the problem
a. Review evidence-based literature for similar problems and “population based approaches to
solving the problem and evidence that the approach(es) worked”. This component of the
assignment requires eight (8) evidence-based articles.
Develop an evaluation plan. Review the nine steps of a program evaluation on page 126 of the
textbook. Use these steps as a guide for your evaluation plan. Ensure that your evaluation plan
includes and thoroughly describes each of these nine steps.
Identify “priority health problems”
Understand underlying factors that contribute to the problem
Review Healthy People 2020 42 topics listed on page 112 of the textbook and determine if the problem
you have identified is on the list.
Review the following models in the textbook and determine which model(s) applies to your community
assessment: Precede-Proceed Model, Change model, Logic model
Review and apply the five steps to program evaluation found on page 124 of the textbook. The
evaluation models include formative evaluation, process evaluation and summative evaluation.
The community assessment should detail the program planning, interventions and evaluation of the
health problem that you selected for the population that you chose in week 1 of the course.
References Submitted:
Chlebowy DO & Garvin BJ.(2006). Social support, self-efficacy, and outcome expectations:
impact on self-care behaviors and glycemic control in Caucasian and African American
adults with type 2 diabetes. Diabetes Educ.32(5):777–86.
Collins-McNeil J., Edwards C.L., Batch B. Benbow D., McDougald C. & Sharpe D. (2012). A
culturaly Targeted Self-Management Program for African Americans with Type 2 Diabetes
Mellitus. Can J Nurs Res. 44(4): 126-141.
D’Eramo-Melkus G, Spollett G, Jefferson V, et al.(2004). A culturally competent intervention of
education and care for Black women with type 2 diabetes. Appl Nurs Res. 17(1):10–20.
Harris MI, Flegal KM, Cowie CC, et al. (2001). Prevalence of diabetes, impaired fasting glucose,
and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition
Examination Survey. Diabetes Care.21(4):518–24
Norris SL, Engelgau MM, Narayan KM.(2001). Effectiveness of self-management training in
type 2 diabetes: a systematic review of randomized controlled trials. Diabetes
Care.24(3):561–87. 19.
Samuel-Hodge CD, Keyserling TC, Park S, et al.(2009). A randomized trial of a church based
diabetes self-management program for African Americans with type 2 diabetes. Diabetes
Educ. 35(3):439–54.
Health Plan to Reduce Catheter-Associated Infections in an Acute Care Hospital
Over one million people develop healthcare-associated infections with 100,000 of
those who die due to complications associated with infections (Clarke et al., 2013).
Health-care associated infections are part of the Healthy People 2020 topics. Catheterassociated urinary tract infections (CAUTI) are the most common hospital acquired
infection accounting for 70%-80% of all urinary tract infections (Lo, et al., 2014).
Infection is the most common adverse effect of indwelling urinary catheters (Lo, et al.,
2014). The duration of catheterization increases the risk for infection by 3% to 8% each
day of catheterization (Adams, Bucior, Day, & Rimmer, 2012). Also, the diagnosis for
CAUTI can be difficult due to asymptomatic bacteriuria that can be misdiagnosed which
can lead to inappropriate use of antibiotics (Adams, Bucior, Day, & Rimmer, 2012).
CAUTI leads to increased healthcare costs, increased hospital stays, and patient
morbidity (Parry, Grand, & Sestovic, 2013). Furthermore, the Centers for Medicare and
Medicaid Services have stopped paying for costs related to hospital-acquired CAUTIs
(Parry, Grand, & Sestovic, 2013). Hospitals are required to report CAUTI and other
hospital acquired infections to the CDC (Dudeck et al., 2013). The cost of CAUTI is
estimated to be $1200-$4700 per patient (Clarke et al., 2013). The biggest contributing
factor to the cause of CAUTI is inappropriate use of indwelling catheters which have
caused an avoidable burden to patients (Parker et al., 2017). There have been
improvements to prevent hospital-acquired infections, but more improvement is needed
(United States Department of Health and Human Services, 2014). This health plan
focuses on reducing CAUTI at the Minneapolis VA Hospital for inpatient units by
reducing CAUTI by at least 50% and reducing urinary catheter use of 75% by improving
CAUTI policies, educating staff, and surveilling staff adherence.
There have been efforts by many hospitals to reduce the incidence of CAUTI. Lo
et al., 2014) found a “systemic review in hospitalized patients reported that the use of
intervention including a reminder to staff that a catheter was in place and a stop order to
prompt removal of unnecessary catheters reduced CAUTI by 53%” (p.465). CAUTI was
found to be reduced by 17.5% to 6.6% when there were policies in place that follow
criteria for indications to insert and continue indwelling catheters (Lo et al., 2014). In
Michigan, there was a statewide program that decreased CAUTI from 18.1% to 13.8% by
providing education to staff on appropriateness of indwelling catheters and daily
assessment of catheter indication (Lo et al., 2014). Nurse initiated catheter removal
protocols have reduced CAUTI by 25% in Michigan hospitals (Lo et al., 2014).
Introducing catheter bundles that aim to reduce CAUTI including avoidance of catheter
insertion, timely removal, and correct management of catheters reduced CAUTI from
18.5% to 9.2% (Lo et al., 2014). Also, introducing CAUTI bundles that included silver
alloy catheters, use of securement devices, keeping catheter bag off the floor, and better
documentation reduced the CAUTI rate by 71% (Clarke et al., 2013). Strategies should
be implemented such as having only trained staff insert catheters under aseptic technique,
supplies for insertion are available and conveniently located for staff, and surveillance to
support catheter use and outcomes (Lo et al., 2014). The recommended criteria for
inserting an indwelling catheter includes perioperative for certain surgical procedures,
hourly assessment of urinary output is needed in ICU units, management of acute urinary
retention and obstruction, to aid in healing of open pressure ulcers or skin grafts for
patients with urinary incontinence, and at a patient’s request at the end of life for comfort
(Gould, Umscheid, Agarwal, Pegues, & HICPC, 2017). It is essential for healthcare
providers to be aware of the criteria for both indication and maintenance of catheters
(Underwoord, 2015).
There are risk factors that can contribute to CAUTI in acute care settings that
include age, neutropenia, renal disease, and males (Lo et al., 2014). The biggest risk
factor for CAUTI is the duration of catheterization (Lo et al., 2014). The reservoir for
infection is the drainage bag, so infection can be transmitted to other patients by
healthcare workers (Lo et al., 2014).
Plan & Objectives
The clearest evidence shows that reducing indwelling catheter use reduces
CAUTI and is the most effective method to reduce CAUTI. The goal is to reduce
catheter-associated urinary tract infections (CAUTI) at the Minneapolis VA Hospital in
inpatient units. CAUTI is the most common hospital acquired infection as well as the
one of the most preventable. The VA Minneapolis hospital was reviewed to assess
indwelling catheter policies. The VA Minneapolis was following many of the
recommended guidelines including using a closed drainage system, using aseptic
technique, education to staff on insertion, and methods to reduce catheterization. One
area that needed improvement was implementing better documentation of catheter
insertion and removal, indication for the catheter on the physician’s order, and daily
assessment of need to continue indwelling catheters. There were no stop orders for
catheters which caused some missed care for catheter removal or re-insertion.
The objectives of the CAUTI health plan are to reduce catheter-associated
infections by creating insertion and removal templates for nursing staff, daily
documentation in nursing notes for indication, policies that follow recommended criteria
for catheter insertion, indication on physician order for insertion, and automatic stop
orders when insertion order is written (Lo et al., 2014). Also, implementing a nurse
driven catheter removal protocol when criteria is met to continue the indwelling urinary
catheter (Lo et al., 2014). Nurse driven protocols have been found to reduce indwelling
urinary catheter use by 50.2% (Parry, Grant, & Sestovic, 2013). A nurse driven protocol
will involve nurse removal of indwelling urinary catheters when criteria is not met (Parry,
Grant, & Sestovic, 2013). When nurse-initiated removal protocols were initiated at a
community hospital, staff compliance improved to 88% (Mari, 2014).
The guidelines for the nurse-initiated protocol will be implemented on the spinal
cord injury unit which has a high number of indwelling urinary catheters. Indwelling
catheter continued need will be assessed daily by the day shift nurse and documented in
the nurse shift note. The criteria to continue an indwelling catheter includes perioperative
use for select surgical procedures (urologic, GI, prolonged surgeries, large volume
infusions or diuretics during surgery, intraoperative monitoring of urinary output), hourly
assessment needed for ICU patients, management of acute urinary retention, for
assistance with healing open pressure ulcers or skin grafts, patients with urinary
incontinence, and end of life care per patient’s request to improve comfort (Mari, 2014).
When nurses followed the indwelling catheter indication criteria indwelling catheter use
was reduced by 17% in just a two-month period (Adams, Bucior, Day, & Rimmer, 2012).
When the criteria are met to continue to indwelling catheter, the day shift nurse will re-
asses each day. When the nurse indicates that the indwelling catheter should be removed
a protocol will be followed. This will include removing the indwelling catheter assessing
for spontaneous voiding, patient not voiding but expresses no urge to void, and if the
patient is uncomfortable and has the urge to void (Mari, 2014). The nurse will bladder
scan the patient if the patient is uncomfortable with no urge to void, the patient has an
urge to void but is unable to do so, the patient is incontinent, and if the patient has not
voided in over 6 hours (Mari, 2014). If patient is uncomfortable and has the urge to void
and the bladder scan is more than 400, the nurse will perform straight catheterization one
time and notify the physician (Mari, 2014). The nurse will also attempt to use external
catheter devices such as condom catheters when appropriate.
To improve documentation, an insertion and removal template will be created for
the nurse to complete. The templates will include the licensed staff name, date and time,
indication, size of catheter, and aseptic technique. There will also be mandatory
education sessions on new documentation, insertion, aseptic technique, unobstructed
urinary tubing, bag below bladder and not on the floor, closed drainage systems, catheter
care, collecting urine samples correctly, securement devices, indications for indwelling
catheters, bladder scanning protocols, and removal protocol. The staff will follow
indication criteria or may fill in other with a comment for special circumstances the
doctor may order.
Evaluation Plan
The first step of evaluation is to identify the stakeholders, and this is completed
before the program begins (Savage, Kub, & Graves, 2016). The stakeholders should
include the staff on the evaluation team, staff from the area of the interventions (staff
nurse, etc.), and what community representation is needed for the program (Savage, Kub,
& Graves, 2016). For the CAUTI health plan which focuses on reducing healthcareassociated infections there are numerous stakeholders that should be included. The
stakeholders should include the nurse manager, assistant nurse manager, staff nurse team,
HAI unit champions, infection control nurse, documentation department, nursing practice
committee chairs, manager of housekeeping staff, housekeeping staff champions,
research team, nurse informatics and nursing assistant unit champions. Including these
stakeholders will give a more in-depth perspective of evaluation of the objectives.
The second step is to develop questions. The questions are created by the
stakeholders and will determine the program improvements and effectiveness (Savage,
Kub, & Graves, 2016). Questions should include what data needs to be collected, the
information needed, what the goals of the program are, and what needs to be
accomplished (Savage, Kub, & Graves, 2016). This step also includes how the
information will be communicated, what information will be communicated, and who it
will be communicated to (Savage, Kub, & Graves, 2016). The focus of the health plan
will be to reduce catheter-associated infections. The data that needs to be collected is the
number of CAUTI in inpatient units, the number of indwelling catheters, the duration of
catheterization, risk factors that increase CAUTI, current policies for CAUTI detection,
current policies for CAUTI management and prevention, review of indwelling catheter
documentation, policies on indwelling catheter insertion techniques, audit of staff
competencies for indwelling catheter insertion, and the indication for indwelling catheters
(Lo et al., 2014). The goals of the program are to reduce CAUTI in inpatient units,
improve policies for indwelling catheters, and educate staff on CAUTI prevention and
indwelling catheter use. The data collected will help create more focused goals that may
include documentation improvements, nurse driven indwelling catheter removal policies,
better communication on indwelling catheter indications, and more focused policies for
indwelling catheter use (Lo et al., 2014). Once data is collected and the research team has
developed current evidence-based practice, the stakeholders will review the data and
develop policies to improve indwelling catheter management to reduce CAUTI in
inpatient units. The new changes will be trialed on the spinal cord unit which has a higher
number of indwelling catheters than other units. When the trial is completed and if
improvements are noted, the information will be communicated to staff with mandatory
educational classes.
Step three of program evaluation is to create a budget (Savage, Kub, & Graves,
2016). The budget can vary depending on the staff needed, size of the program, and
equipment that is needed (Savage, Kub, & Graves, 2016). For the CAUTI health plan, the
staff will meet weekly for two hours to discuss the plan and goal progression during their
normal scheduled hours. The research and informatics team will work their normal hours
with the focus on the CAUTI health plan. The staff teams of nurses, nursing assistants,
housekeeping staff, and nurse managers will focus one-two hours per scheduled shift to
the CAUTI program. The infection control nurse will assist with research and evaluating
infection control on all inpatient units. The goal is for the program to be completed within
six months. The budget for the program should not exceed more than $20,000 as most
staff will be working their normal schedules. Data processing systems are already in
place, so no extra costs should be acquired.
Step four of program evaluation will be whether to have internal or external
evaluators (Savage, Kub, & Graves, 2016). The program will be evaluated by internal
infection control nurses that are not directly involved in the project to prevent biases. It is
important to have external evaluators present for the program planning process (Savage,
Kub, & Graves, 2016).
Steps five through seven include the program implementation phase (Savage,
Kub, & Graves, 2016). Data collection methods are determined in step five, data is
collected in step six, and data is analyzed and interpreted in step seven. For the CAUTI
program, data will be collected by completing chart audits and observation of staff’s
infection control methods during catheterization and during catheterization insertion. The
spinal cord unit will have a CAUTI champion that is not known to staff that can observe
staff. The infection control nurse can also make unannounced visits to the unit to assess
infection control measures and compliance. The research team and nurse informatics will
analyze and interpret the data collected. The documentation team will create insertion and
removal templates, as well as improve physician orders that include indication and create
automatic stop orders.
Step eight is completed when the evaluation is complete. The data collected is
presented to all the stakeholders (Savage, Kub, & Graves, 2016). This will be conducted
by holding a meeting with all stakeholder’s present.
Step nine involves using the evaluation information to prove or improve the
program (Savage, Kub, & Graves, 2016). The information needs to include all data
collected as well as the data analyzed and interpreted (Savage, Kub, & Graves, 2016).
This helps improve the program decisions (Savage, Kub, & Graves, 2016). For the
CAUTI program, the information will be presented to the administrative leadership with
the goal of attaining more funding to improve the CAUTI program in the hospital.
Logic Model
The logic model can be used for the CAUTI health plan to help guide in careful
and well thought out planning (Savage, Kub, & Graves, 2016). The CAUTI plan will be
clear when implemented and evaluated (Savage, Kub, & Graves, 2016). The CAUTI
team has developed clear objectives and expected outcomes for the project (Savage, Kub,
& Graves, 2016). The resources needed for the project are human resources. The projects
that are used currently are appropriate in reducing CAUTI. Staff will be working their
normal hours with a focus on the CAUTI project. The activities for the CAUTI health
plan have been identified with each stakeholder contributing to the project. Educational
staff will be involved to educate the staff on the spinal cord injury on the trial for the
CAUTI project. Next, the output of the project will be better documentation to reduce
CAUTI by ultimately reducing indwelling catheters on the spinal cord injury unit. Once
the trial is completed, the team will meet to discuss any needed changes to the new
interventions. Then, the team will present the changes to the nursing practice council and
leadership in the hospital to make the change effective hospital wide. The intended
outcomes of the CAUTI project will be to reduce the use of indwelling catheters thus
reducing CAUTI hospital wide. The impact of the CAUTI project will be a significant
reduction in CAUTI hospital wide.
The first step in evaluation is formative evaluation. This evaluation is done when
the program is being developed (Savage, Kub, & Graves, 2016). This step is completed
to get feedback during the early stages of the program and makes changes as needed
(Savage, Kub, & Graves, 2016). The CAUTI team will get feedback from the spinal cord
injury unit staff to determine if interventions are attainable and feasible. This will give
the team the opportunity to make changes to interventions as needed. This team will meet
with staff on the unit weekly during the trial to get feedback.
The second step is the process evaluation. This involves documenting how the
program was delivered and if the delivery was what was designed in the program design
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