DNP Project: A Clinical Nurse Specialist Led Diabetes Self-Management Intervention
Topic of Interest
CNS as Project Manager
Quality Initiatives
Patient Populations
Capture Value of the CNS
Interprofessional Collaboration
Abstract
Title: A Clinical Nurse Specialist Led Diabetes Self-Management Intervention
Significance & Background: Individuals with diabetes are two times more likely to suffer from a stroke, with elevated blood sugars associated with micro- and macrovascular complications and risk of recurrent stroke. Ninety-one percent of stroke risk is attributed to modifiable risk factors, and in terms of hyperglycemia, 50% of individuals with diabetes have suboptimal glycemic control. Diabetes self-management education and support (DSMES) interventions are associated with improved glycemic control and fewer micro- and macrovascular complications. Despite this knowledge, less than 10% of individuals with diabetes participate in these programs. In many instances, the impact of stroke in terms of modifiable risk factors and disease burden is not well addressed during hospitalization resulting in significant gaps in care management. Additionally, stroke often requires family support to help manage the condition. The purpose of this project is to design and implement an evidence-based intervention to improve diabetes self-management behaviors in patients who suffered a stroke at Midwestern Level 1 trauma center, and teaching hospital. Currently the clinical nurse specialist (CNS) provides diabetes teaching for the stroke team, but the consultation process is not well-structured or utilized.
Evaluation Methods: (In progress) The intervention for this project is a structured DSMES consultation intervention based on evidence-based guidelines. The intervention will be implemented over the course of twelve weeks using the Individual and Family Self-Management Theory as a framework to guide the consultation intervention. Using a screening algorithm, the CNS will screen stroke patients with diabetes or their designated caretaker for the consultation intervention. Validated tools to assess baseline diabetes knowledge (KNOW Diabetes Test) and diabetes self-efficacy (Diabetes Empowerment Scale-Short Form [DES-SF]) will be administered prior to receiving the DSMES consultation and after discharge.
Outcomes: (In progress) Diabetes knowledge and self-efficacy will be evaluated prior to the consultation and once the patient discharges. Additionally, satisfaction with the intervention will be evaluated after discharge using a survey. Consultation data will also be collected and include: patient age, type of stroke, type of diabetes and whether a new diagnosis, length of stay, time to complete consultation in minutes, date of discharge, recipient, type of follow-up, follow-up attempts, a post-discharge patient satisfaction survey, and 30-day readmissions if available.
Implications: (In progress) Overall, the aim of this project is to improve and standardize the current DSMES consultation using evidence-based practice. The results of this project will also provide valuable data to improve and potentially support expansion of the current CNS consulting process.