DISCUSSION: THE DNP NURSE AND COMMUNITY
DISCUSSION: DNP PREPARED NURSE AND THE COMMUNITIES
Expand discussion thread from Ron Adolph
The need for diabetes education for elderly outpatients in a community health clinic
The public health sector is crucial in preventing and managing various chronic medical conditions. However, there is a significant shortage of Advanced Practice Nurses (APNs) specializing in public health, as highlighted by Bekemeier et al. (2021). Additionally, the availability of specialized educational programs to prepare nurses for these roles remains insufficient to meet the growing demand (Bekemeier et al., 2021). Diabetes is one such chronic disease that disproportionately affects the elderly population. According to the Centers for Disease Control and Prevention (CDC, 2022), approximately 25% of adults over the age of 65 are affected by diabetes. Often, elderly individuals seek healthcare from community-based resources and face multiple comorbidities, complicating their care management (Kirkman et al., 2012). These factors underscore the importance of structured diabetes education in improving health outcomes and quality of life. Barriers to effective diabetes management include limited health literacy, polypharmacy, sensory impairments, and social isolation. Therefore, community-based educators can be highly effective by providing simplified instructions and focusing on self-management. Let’s delve deeper into this topic.
Limited Health Literacy
Research indicates that health literacy declines with age, and limited comprehension of medical instructions is linked to poor glycemic control in older adults (Kobayashi et al., 2014). This demographic often faces challenges with complex treatment regimens, which can result in medication administration errors or difficulties in glucose monitoring.
Polypharmacy
It is very rare for an elderly patient to have only one chronic condition and be taking a single medication. The elderly often battle several chronic conditions while taking multiple medications. Taking multiple medications increases the risk of drug interactions, confusion, and noncompliance among this population. These factors further complicate the management of diabetes (American Geriatrics Society, 2019).
Sensory Impairments
Vision and hearing impairments associated with aging can impede patients’ ability to read medication labels, measure insulin accurately, or adhere to healthcare providers’ instructions (Reichard et al., 2017). Assisting patients with finding community resources can positively impact their quality of life and prevent injury.
Social Isolation
Older adults living alone or with little social support may face emotional stress and lack help with self-care, leading to poor diabetes management (Holt-Lunstad et al., 2015)
The Role of Diabetes Education
Providing diabetes education in community health settings is essential for helping elderly patients manage their condition better. Evidence-based diabetes self-management education (DSME) programs improve outcomes like blood sugar control, medication adherence, and self-confidence (Powers et al., 2017). Key components of an effective DSME program for elderly outpatients include:
Simplified Instruction: Tailor educational content to the cognitive and sensory needs of elderly patients using visual aids, large-print materials, and hands-on demonstrations (Bailey et al., 2014).
Focus on Self-Management: Emphasize self-care skills such as blood glucose monitoring, symptom recognition, medication management, and foot care to prevent complications (American Diabetes Association [ADA], 2023).
Nutritional Counseling: Provide personalized dietary advice that is culturally sensitive and realistic, considering the patient’s access to healthy food and nutritional preferences (Evert et al., 2019). The current ADA guidelines prioritize managing carbohydrates over counting calories for blood glucose control (American Diabetes Association, n.d.) The educator should explain that carbohydrates directly impact blood sugar levels, so it’s important to monitor both the type and amount of carbs consumed, especially during meals. While calorie intake is still important for overall health and weight management, carbohydrate counting is key for diabetes care. Highlight that the goal is to maintain stable blood sugar levels through mindful carbohydrate choices.
Support Systems: Provide personalized dietary advice that is culturally sensitive and realistic, considering the patient’s access to healthy food and nutritional preferences (Evert et al., 2019).
Conclusion
In community health clinics, diabetes education is essential for empowering elderly outpatients to manage their condition effectively. By addressing challenges such as low health literacy, polypharmacy, and sensory impairments and offering tailored education and support, healthcare providers can greatly enhance outcomes for elderly patients. Incorporating evidence-based Diabetes Self-Management Education (DSME) programs into routine care will not only help alleviate the burden of diabetes but also improve the quality of life and overall well-being of this vulnerable population.
References
American Diabetes Association. (n.d.). Understanding carbs. ADA.
American Diabetes Association. (2023). 7. Diabetes technology: Standards of medical care in diabetes—2023. Diabetes Care, 46(Supplement 1), S50-S61.
American Geriatrics Society. (2019). Updated AGS beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694.
Bailey, S. C., Oramasionwu, C. U., & Wolf, M. S. (2014). Rationale and design of a tailored educational intervention to improve diabetes self-management skills. Patient Preference and Adherence, 8, 629–638.
Bekemeier, B., Kuehnert, P., Zahner, S. J., Johnson, K. H., Kaneshiro, J., & Swider, S. M. (2021). A critical gap: Advanced practice nurses focused on the public’s health. Nursing Outlook, 69(5), 865–874.
Centers for Disease Control and Prevention (CDC). (2022). National diabetes statistics report.
Evert, A. B., Dennison, M., Gardner, C. D., et al. (2019). Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Diabetes Care, 42(5), 731–754.
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237.
Kirkman, M. S., Briscoe, V. J., Clark, N., et al. (2012). Diabetes in older adults: A consensus report. Journal of the American Geriatrics Society, 60(12), 2342–2356.
Kobayashi, L. C., Wardle, J., Wolf, M. S., & von Wagner, C. (2014). Aging and functional health literacy: A systematic review and meta-analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71(3), 445–457.
Reichard, A., Stolzle, H., & Fox, M. H. (2017). Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States. Disability and Health Journal, 10(2), 219–226.
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CLARA’S POST
The selected community of practice centers on aftercare services for individuals facing mental health challenges. Aftercare encompasses the support and services offered to patients after discharge from acute or inpatient mental health facilities. This community comprises healthcare providers, nurses, social workers, and mental health professionals who collaborate to ensure that patients receive ongoing care, thereby preventing relapses and fostering long-term recovery.
Comprehensive aftercare services are vital for individuals with mental health challenges like depression, anxiety, schizophrenia, or bipolar disorder, as they need ongoing support to manage their conditions and reintegrate into their communities. Insufficient aftercare increases the risk of relapse, rehospitalization, and worsening mental health (Samartzis & Talias, 2019). This community of practice aims to provide resources for those transitioning from inpatient care. However, service gaps can lead to negative outcomes, such as higher hospitalization rates and treatment non-compliance (Hegedüs et al., 2020). Hegedüs et al. (2020) note establishing effective aftercare is essential for improving patient outcomes, reducing healthcare burdens, and enhancing the quality of life for those with mental health disorders.
Importance of Addressing the Need.
As a future DNP-prepared nurse, it is imperative to address the deficiencies in aftercare services for several key reasons:
Continuity of Care: Patients often face challenges in obtaining consistent care after being discharged from mental health facilities. Those with severe mental health disorders may experience difficulties with disruptions in medication management, therapy sessions, and access to community support services (Choi et al., 2020). Ensuring a seamless transition from inpatient to outpatient care is essential to reduce the likelihood of relapse and subsequent rehospitalization (Mongelli et al., 2020). For instance, consider a patient diagnosed with schizophrenia who requires ongoing medication management and regular therapy sessions. Without consistent follow-up, such patients may be tempted to discontinue their medication due to side effects or a lack of understanding, which can result in a relapse. Effective aftercare is vital for assisting patients in maintaining the progress achieved during their hospitalization and providing continuous support as they reintegrate into their communities (Choi et al., 2020).
Reducing Rehospitalization Rates: Inadequate aftercare considerably increases patients’ risk of being readmitted due to relapse (Vernon et al., 2019). Studies show that mental health patients discharged from facilities without comprehensive aftercare are twice as likely to be readmitted within 30 days. Implementing effective aftercare strategies can significantly reduce these rates, thus easing the strain on hospitals and improving long-term patient outcomes (Vernon et al., 2019). For instance, a 28-year-old individual diagnosed with major depressive disorder faced a relapse within a month of discharge after failing to attend follow-up therapy sessions. A subsequent assessment indicated that limited transportation options and feelings of isolation were critical contributors to this relapse. This scenario highlights the pressing need for tailored aftercare plans that consider the specific circumstances of patients, particularly regarding access to resources and social support. Therefore, nurses holding Doctor of Nursing Practice (DNP) degrees are ideally positioned to advocate for improved aftercare systems.
Holistic Patient Well-Being: The journey to recovery from mental health challenges extends beyond mere symptom management; it necessitates social reintegration and the ability to participate in everyday activities (Dayson et al., 2020). Aftercare services that encourage community engagement, vocational training, and psychosocial support play a vital role in this recovery process (Samartzis & Talias, 2019). As a nurse with a Doctor of Nursing Practice (DNP), I would advocate for implementing more holistic aftercare strategies that address multiple facets of recovery. For instance, consider a 32-year-old individual diagnosed with post-traumatic stress disorder (PTSD) following a traumatic experience. After discharge, this individual encountered significant obstacles in obtaining employment and stable housing, exacerbating their mental health struggles. The introduction of comprehensive aftercare services that prioritize social determinants of health, such as job placement and housing assistance, could significantly reduce these challenges and promote sustained recovery. Nurses holding a DNP degree are responsible for championing policies and practices that consider the social influences on mental health outcomes, ensuring that patients receive comprehensive support throughout their recovery journey.
Recommended Practice Changes to Address the Need.
Given the challenges outlined above, it is recommended to implement two key practice changes: integrating telehealth services into aftercare programs and creating peer support initiatives. These evidence-based approaches align with DNP-prepared nurses’ goals, focusing on enhancing patient care through innovative and patient-centered strategies.
Telehealth in Aftercare Services: Research conducted by Molfenter et al. (2021) indicates that integrating telehealth services into mental health aftercare significantly enhances patient engagement and accessibility. Numerous patients encounter obstacles that hinder their ability to attend in-person follow-up appointments, including issues related to transportation, stigma, or physical health challenges. Telehealth facilitates the participation of patients in therapy sessions, medication management consultations, and peer support groups from their own homes, thereby promoting continuity of care. For instance, a patient experiencing social anxiety may struggle to visit a mental health clinic physically yet can successfully engage in virtual therapy sessions, ensuring consistent follow-up and support without the additional pressure of travel.
Peer Support Programs: Programs that facilitate peer support, wherein individuals who have experienced mental health challenges help others in their recovery journey, have demonstrated improved patient outcomes (Fortuna et al., 2022). Peer support workers bring valuable perspectives and emotional backing that may not be available from traditional healthcare professionals (Bjørlykhaug et al., 2021). Bjørlykhaug et al. (2021) note these initiatives promote a sense of community and alleviate feelings of isolation, essential for patients moving beyond acute care settings. For instance, a peer support worker who has personally dealt with substance abuse issues can guide a recently discharged patient in overcoming the difficulties of reintegrating into daily life, offering practical advice and motivation based on their own experiences.
Alignment with the Essentials.
These suggestions correspond with various specific Domains outlined in The Essentials.
Domain 2: Person-Centered Care: Telehealth and peer support initiatives highlight the significance of tailored care. Telehealth offers patients the convenience of receiving treatment that aligns with their specific needs and situations (Talal et al., 2020), while peer support provides essential emotional and social assistance from individuals who share similar experiences.
Domain 5: Quality and Safety: Enhancing aftercare services through telehealth and peer support initiatives directly affects the quality and safety of mental health care. This approach contributes to lower rehospitalization rates, promotes medication adherence, and improves the overall effectiveness of follow-up care (Banbury et al., 2021). Such efforts align with DNP nurses’ objectives to apply evidence-based practices that enhance patient outcomes.
Domain 6: Interprofessional Partnerships: The successful integration of peer support programs and telehealth necessitates collaboration among professionals, including nurses, social workers, psychologists, and peer support specialists. The capacity to work together across various disciplines is essential for providing comprehensive and effective mental health aftercare (McCord et al., 2024).
In summary, aftercare services for individuals facing mental health challenges play an essential role in the recovery journey. By identifying and addressing deficiencies in aftercare, healthcare professionals can enhance patient outcomes, lower rehospitalization rates, and foster sustained recovery. Evidence-based interventions such as telehealth services and peer support programs significantly promise to improve aftercare services. These modifications not only enhance accessibility and patient involvement but also resonate with critical domains outlined in The Essentials, such as person-centered care, quality and safety, and interprofessional collaboration. As future DNP-prepared nurses, it is imperative that we champion these initiatives to ensure that individuals with mental health issues receive the comprehensive and holistic care necessary for their well-being.
References
Banbury, A., Pedell, S., Parkinson, L., & Byrne, L. (2021). Using the Double Diamond model to co-design a dementia caregivers telehealth peer support program.
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Bjørlykhaug, K. I., Karlsson, B., Hesook, S. K., & Kleppe, L. C. (2021). Social support and recovery from mental health problems: a scoping review.
Nordic Social Work Research,
12(5), 666–697.
to an external site.
Choi, Y., Nam, C. M., Lee, S. G., Park, S., Ryu, H., & Park, E. (2020). Association of continuity of care with readmission, mortality and suicide after hospital discharge among psychiatric patients.
International Journal for Quality in Health Care,
32(9), 569–576.
to an external site.
Dayson, C., Painter, J., & Bennett, E. (2020). Social prescribing for patients of secondary mental health services: emotional, psychological and social well-being outcomes.
Journal of Public Mental Health,
19(4), 271–279.
to an external site.
Fortuna, K. L., Solomon, P., & Rivera, J. (2022). An update of Peer Support/PEer provided services underlying processes, benefits, and critical ingredients.
Psychiatric Quarterly,
93(2), 571–586.
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Hegedüs, A., Kozel, B., Richter, D., & Behrens, J. (2020). Effectiveness of Transitional Interventions in Improving patient outcomes and service use after Discharge from Psychiatric inpatient Care: A Systematic Review and Meta-Analysis.
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McCord, C., Garney, W., Garcia, K., Macareno, B., & Williamson, M. (2024). Evaluation of a multi-site health services psychology training program for telehealth and integrated behavioral health.
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Molfenter, T., Heitkamp, T., Murphy, A. A., Tapscott, S., Behlman, S., & Cody, O. J. (2021). Use of telehealth in mental health (MH) services during and after COVID-19.
Community Mental Health Journal,
57(7), 1244–1251.
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Mongelli, F., Georgakopoulos, P., & Pato, M. T. (2020). Challenges and opportunities to meet the mental health needs of underserved and disenfranchised populations in the United States.
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Samartzis, L., & Talias, M. A. (2019). Assessing and improving the quality in mental health services.
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Talal, A. H., Sofikitou, E. M., Jaanimägi, U., Zeremski, M., Tobin, J. N., & Markatou, M. (2020). A framework for patient-centered telemedicine: Application and lessons learned from vulnerable populations.
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Vernon, D., Brown, J. E., Griffiths, E., Nevill, A. M., & Pinkney, M. (2019). Reducing readmission rates through a discharge follow-up service.
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