Free «Improving Self-Management Knowledge in Hispanic Adults with Type 2 Diabetes Mellitus» Essay Paper

Diabetes constitutes one of the main challenges for the U.S. health care system while the scale of the appearance and severity of its complications every year becomes greater. The life-long holistic care and patient-centered attitude to the problem mean that the solutions are possible in the variety of clinical settings and with a help of the advanced nursing practice. The fast-growing Hispanic population experiences the most of the difficulties on the way to the efficient management of the disease. The educational program with culturally tailored construction suggests the focus of the evidence-based project. The study aims at discovering how the improvement of self-management knowledge in Hispanic adults with type 2 diabetes mellitus contributes to the advances in the diabetes control.

The Interest about the Problem

The interest about the problem reveals the significance of the progressive diabetes character, the costly health care services, and disparities in its management. Underinsurance and insufficient coverage of minority groups with the health professional’s supervision generate additional pressure on the control of public health. According to the national initiative Healthy People 2020, advances in the management of diabetes refer to the priorities of the health care system development (“Diabetes,” 2016).

Besides, the diabetes risk manifests in the apparent disparities. Hispanic adult population, together with African and Asian Americans are at risk of Type 2 Diabetes Mellitus (T2DM) (“Diabetes,” 2016). Moreover, the Latinos represent the group with the fastest-growing population in the United States. Hispanic adults are in the great risk group of T2DM appearance due the genetic predisposition of obesity, cultural and financial barriers, and higher glycosylated hemoglobin (HbA1c) respectively. American Diabetes Association (2014) determines the cardiometabolic abnormalities the prevalent risk factors of Hispanics comparing to other ethnic groups. Moreover, the rate of hospitalizations because of uncontrolled diabetes is higher in the Hispanic group (Hu, Amirehsani, Wallace, & Letvak, 2013). Uncontrolled comorbidities are other causes of the costly and long-time rehabilitation and physical inability. The diabetes exacerbations in the group highly depend on the self-management knowledge, skills, and tailored professional support. In the case of the optimal combination, they lead to the individual proactive attitude to the chronic disease. The knowledge gap hinders the process of the transformation of professional care to the self-care. The advanced nurse possesses enough skills, competencies, and passion for guiding the transformation process.

Relation to the Nurse Practitioner’s Specialization

The lack of resources and support are the chief barriers to the healthy lifestyle of diabetes patients that the nurse practitioner can diminish. The nurse practitioner’s (NP) assistance manifests in the assessment of physical and emotional needs of the patients to initiate the patient-centered education, supervision, and support. Richardson, Derouin, Vorderstrasse, Hipkens, and Thompson (2014) distinguished the leading role of a nurse practitioner in helping adults to cope with HbA1c and improving the self-care skills. They stress on the low self-efficacy of diabetes patients as the primary barrier to effective self-management. Because of the NP intervention and support, the patients achieved better scores for blood pressure (BP), lipid and body weight control (Richardson et al., 2014). The health care team activities as well as in the case of a single provider revealed such improvements.

The NPs, according to the range of their expertise can modify the planned options in response the conditions and the health status. Alongside, in the interviewing survey by Hu et al. (2013), Hispanic adults considered an insufficient support of health care providers one of the causes of their helpless situation.  The latter appears to be also the result of the family members’ misunderstanding of living with diabetes. Accordingly, the family background is under conditions that need supervision to obtain projected outcomes of the intervention. The planned intervention relies on the evidence concerning the problem existence, lack of self-management knowledge among Hispanic patients, and the influence on the quality of life.

Evidence to Support the Changes

The identified evidence, first, discovers the lack of access to the culturally specified self-care training for the Hispanic adults with T2DM that distinguishes the problem within the project. The self-care concerns the necessary component in the provision of holistic care to the vulnerable population with risky health behaviors and genetic predisposition. Second, the self-care relates to the dynamic process of the knowledge development that determines the ability for the life-long survival and well-being. The level of participation of patients in the health care predisposes the diabetes development and capacity to diminish the complications. The patients that had not received the diabetes education have the four-fold increase in diabetes comorbidities (Shrivastava, Shrivastava, & Ramasamy, 2013). The level of participation in the educational programs is lower than 10% of the diabetes population.

In the long-term scale, the diabetes patients continue to demonstrate the low adherence to the essential self-care behaviors. They primarily concern the modification of the healthy lifestyle and glycemic control (Shrivastava et al., 2013). Hispanic adults with T2DM are the group showing insufficient ability in glycemic control and diabetes complications management (Gucciardi, Chan, Manuel, & Sidani, 2013). For example, the report of National Health and Nutrition Examination Survey (NHANES) shows the Mexican Americans have the lowest level of lipid control (LDL-C) in comparison to others (“Diabetes,” 2016). 

Cultural and social background predisposes the differences in the recognition and awareness of the self-care options in Hispanic communities. These factors shape the status of the undertreatment of diabetes and insufficient skills in the self-management issues (Cusi & Ocampo, 2011). The problem of the well-being of Hispanic patients with the chronic condition involves the social context. On the way, the patients, and their families report on the lack of knowledge and misunderstanding of the health-related and nutrition information that hinder the awareness and abilities for family supervision (Hu, Amirehsani, Wallace, & Letvak, 2012; Hu et al., 2013).

Rationale for Improving Outcomes

The earlier mentioned evidence implies to the significance of the knowledge elaboration and creating the conditions for increasing responsibility for self-care among the Hispanic adults with T2DM and their families. The family group is the central social unit in the Hispanic life that directs individual choices and actions. The concept of familismo predisposes the family-centeredness in common solutions of the members, including health. The Brazilian study by Pereira, Costa, Sousa, Jardim, and Zanini (2012) considers the family factor determinative in improving self-care of diabetes patients. Still, the results of the trial show insignificance while initiating the education outside the home environment.

Family-based communication and discussion constitute the option to reach the proposed changes in the health status of the Hispanic patients with T2DM (Hu, Wallace, Mccoy, & Amirehsani, 2014). Due to the strong family traditions and community support, Hispanic families and women, in particular, are more successful in the group-based and home self-management education in comparison to other ethnic communities (Gucciardi et al., 2013). Cultural and financial issues complicating access to health education and support determine the need for the close attention of the health care providers. The issues argue that the need for improvement of current promotional and educational programs that will fit the cultural and family preferences of the patients exists.

The Idea of the Evidence-Based Project

The idea of the study relies on the accomplishments of the diabetes management in the United States and worldwide. The majority of the analyzed systematic reviews and trials argue the necessity and urgency of improving the self-management knowledge in ethnic minorities with T2DM (Chrvala, Sherr, & Lipman, 2015; Gucciardi et al., 2013; Hu et al. 2013; Shrivastava et al., 2013).  The systematic review by Chrvala (2015) supports the efficiency of educational programs based on the National Standards for Diabetes Self-Management Education and Support (DSME). The empowerment- and family-based interventions suppose the acknowledged practice for the Hispanic adults. Altogether, the indicated features and background of the project affirm its evidence-based character and the existence of the evidence-based guidelines for the educational program.

Description of the Intervention

Consequently, the project aims at educational intervention to improve self-management knowledge in the Hispanic population with the high risk, cultural barriers, and the helpless perception of the diabetes process. The population for the project is the most vulnerable to environmental and interpersonal determinants of disease self-management (Hu et al., 2013).

Accordingly, community or home settings appear to be the environments the most suitable for effective communication (Gucciardi et al., 2013). The educational intervention is congruent with evidence-based recommendations of ADA and the American Association of Diabetes Educators (AADE) that is, however, an underutilized component of the diabetes programs (Chrvala et al., 2015). DSME include the educational recommendations. They serve the evidence-base for the educational intervention of the project.

The Task Force determined DSME as the approved guidelines for health management and promotion of people suffering from diabetes in the United States. The Standards’ design helps how to stress the importance of the individual in managing the chronic condition. The self-management is the central issue of the health care intervention (Haas et al., 2014). DSME suggest facilitating knowledge the primary option to solve the problems related to the one identified in the project.

Consequently, the education based on the acknowledged DSME constitutes the most appropriate tool for implementing the changes. The Standard 3 of the DSME refers to improving access to the education while generating the patient-centered and culturally tailored intervention (Haas et al., 2014). Additional specification of DSME for bilingual or Spanish-speaking Hispanic group improves the measurable outcomes of the program (Pena-Purcell, Boggess, & Jimenez, 2011). These aspects of structured education refer to the most complicated in delivering the needed knowledge. The empowerment-based type of DSME may serve the culturally tailored design for the Hispanic communities.

In conclusion, there should be present detected and assessed results of the advanced knowledge. Systematic reviews by Gucciardi et al. (2013) and Chrvala et al. (2015) argue that measurable changes in HbA1c, physical parameters of the body, diet commitment, and healthy lifestyle constitute the most apparent outcomes of the diabetes interventions. Consequently, the mentioned characteristics may identify the results of the evidence-based project. The found evidence imply to the exploration of the 3-6 month period of monitoring health and more than ten contact meetings to discover the outcomes  of the educational program and self-management behaviors (Gucciardi et al., 2013; Chrvala et al., 2015). To achieve the highest results, one should also consider the family bias.

The Relevance to the Family Nurse Practitioner’s Role

The health care intervention and desirable changes for the development of self-management knowledge in Hispanic adults will depend on the family attitude, support, and advances. Hence, the position of the family nurse practitioner seems to be the most appropriate health care professional to influence the level of awareness, recognition, and decision making in the disease-related problems. Family setting and family support provides an essential background for the health maintenance of patients with DM and improving the disease-related knowledge (Hu et al., 2014).

The evidence implies to the importance of family nurse practitioner as a chief person delivering diabetes education to the patients and family members as the potential caregivers and supporters. The position of family nurse practitioner enables to utilize the family setting to encourage the interrelated improvements in diabetes knowledge in the family, as the central social unit in Hispanic culture. Findings by Hu et al. (2014) demonstrate that the participation of family members in the educational self-management programs contributes to the healthy lifestyle in the home environment and hence promotes diabetes self-care. The social constraints are essential in decomposing complex chronic conditions and reinforcing their maintenance (ADA, 2014).

Besides, the family nurses possess the knowledge to deal successfully with the educator’s role while working in the multidisciplinary teams in multicultural environments. Understanding demographic backgrounds of the diabetes self-management of Hispanic patients involves the expertise within the scope of family nurse practitioner practice.  In the light of the problem, the family nurse practitioner may become the change agent in the health promotion while improving the patients and the family awareness of the disease control.

Conclusion

The control over diabetes spreading and treatment in the Hispanic communities lies within the comprehensive, culturally competent, accessible, and promotional health care services. The self-management component serves the indicator of the appropriate functioning health care system directed to increasing the patient’s responsibility and skills. The lack of knowledge, resources, family and professional support constitute vital issues in the educational evidence-based project. The project closely connects with the family nursing that is the most understandable for Hispanic adults with strong family traditions. The advanced nursing practice enables to detect gaps in the self-management knowledge and generate the intervention based on the previous evidence and national standards of diabetes education and support. Educational intervention under the supervision of the family nurse practitioner should result in the measurable outcomes of the diabetes course and quality of life contributing to the cost-efficiency of the diabetes management in general.