Leadership Collaboration Communication Change Management and Policy Considerations
Assessing the Problem: Diabetes Among African Americans
Noncommunicable diseases have contributed significantly to mortality and morbidity among various populations in the United States. Type II diabetes mellitus is one such non-communicable disease that has been studied and documented to have a significant impact on the American population’s health.
According to the centers for disease control and prevention, about 37 million Americans have diabetes mellitus. This means that one person in every ten has diabetes. Unfortunately, about 1 in every 5 persons are unaware that they have diabetes mellites. Among African Americans, diabetes mellitus has been tagged to sociocultural and genetic context (Shiyanbola et al., 2018a).
African American race is one of the ethnicities with the highest prevalence of diabetes mellitus (Ajuwon & Love, 2020). This understanding critically impacts how nursing can be applied to address the situation at the individual and population levels. The purpose of this paper is to assess the diabetes mellitus problem among African Americans from a nursing perspective and propose strategies to address this problem through leadership, collaboration, communication, change management, and policy considerations.
African Americans are the largest minority group in the United States. This population is colloquially referred to as blacks. Chronic diseases most common in this population are depression, anxiety, diabetes, coronary artery disease, hypertension, and substance abuse (Ellis et al., 2020). Type II diabetes is inheritable, but environmental factors and lifestyle play a major role in this causation and pathogenesis.
In this capstone project, African Americans are selected because they have been documented to present worse outcomes in diabetes mellitus progression alongside having a higher prevalence. Recent literature evidence has indicated that diabetes mellitus is increasingly being diagnosed among the younger population, especially black teens (CDC, 2022).
For African American men, the incidence has increased to 160% (Hurt et al., 2020). Adult African Americans are at increased risk. Therefore, this population requires care in all dimensions to prevent and treat type II diabetes mellitus from preventive to curative care models. This project, therefore, focuses on preventative care among adult blacks.
Diabetes mellitus is a disease that requires nursing as well as medical strategies of care. The role of nurses is unhospitable in that various supportive treatments and definitive management of diabetes include nursing intervention. Coordinative care is essential in diabetes management and prevention.
Nursing provides excellent care coordination and leadership that would see the best population health outcomes among this population group. This health problem is relevant to my future practice as a baccalaureate-prepared nurse. The current nursing practice is based on evidence-based practice and cultural sensitivity.
Diabetes management requires cultural sensitivity to understand the patient disease and address specific factors and health determinants that are specific to these patients. Understanding diabetes mellitus among African American adults would enable me to understand and apply the role of culture, family, genetics, and socioeconomic determinants of health among blacks. I would be able to navigate through the gender, family, and cultural norms that determine the incidence of this disease among African American adults.
Analysis of Evidence
Diabetes mellitus among African Americans has been attributed to various factors. Some literature evidence sources attribute this health problem among African Americans to lower health literacy levels. The knowledge of diabetes and this prevention, as well as treatment, is essential in improving outcomes. Skrine-Jeffers et al. (2019) carried out a qualitative study that aimed at addressing the role of informal and formal knowledge about diabetes among African American males with uncontrolled diabetes mellitus. The theme of the social construction of knowledge about diabetes mellitus came out from this study.
African Americans’ construct of knowledge about diabetes mellitus relies upon their lived and observed experiences. Therefore, nurses as patient educators have a crucial role in identifying these experiences in the process of culturally sensitive care. Personalizing patient education is thus an essential strategy when addressing this health problem among African Americans.
Health Literacy and Patient Perception
Patient perceptions of illness are influenced by their cultural contexts. The perception of diabetes among African Americans is influenced by their cultural beliefs and practices. Shiyanbola et al. (2018b) explored the perceptions of African Americans about diabetes mellitus through a qualitative study and concluded that the meaning that African Americans attach to diabetes mellitus plays a vital role in the success of self-management and adherence to medical treatment.
Culturally, this population believes that faith in God and positive thinking about survival are essential strategies for diabetes control. In education and daily experience, blacks tend to be more spiritual than other ethnicities, and this could be an important element in understanding their health determinants.
Barrier to Implementation
Barriers to implementing the nursing intervention in addressing diabetes among African Americans have led to poor disease outcomes. As aforementioned, depression is among the most common chronic diseases among African American adults. Ajuwon & Love (2020) conducted a systematic review study that linked a relationship between diabetes and depression among African Americans to the disease outcomes.
As much as it may be thought that diabetes could be familial, the presence of comorbidities and cultural practices are also important in understanding diabetes among African Americans. The culture, among other health disparities, has a critical role in the prevalence of diabetes among African Americans. As nurses, we require culturally relevant education to mitigate these barriers.
Access and Coverage
Access to primary care and insurance coverage among African Americans has been attributed to the lower success of interventions to lessen the burden of diabetes among African Americans (King et al., 2018; Hu et al., 2021). Nursing standards and policies have a role to play in mitigating these barriers. Nursing education about available universal healthcare coverage, such as the affordable health care act (ACA) and Medicaid, can enlighten patients about the benefits of these federal policies in diabetes management.
According to King et al. (2018), most patients are unaware of familial risk in type two diabetes. Lifestyle, diet, and physical activity are key established risk factors among African Americans. Patient education can help patients reflect on personal barriers to health behavior change and improve their perceptions about diabetes mellitus (Ard et al., 2020). In sum, multidisciplinary involvement is key in addressing the above-explained barriers.
Quality of Evidence Used
The evidence used to support the existence of diabetes as a health problem among African American adults is of good quality and reliable. I have sued both quantitative and qualitative sources to assess the problem. Qualitative studies used are scholarly and do not just represent expert opinions but are systematically carried out and documented in scholarly and peer-reviewed studies. They have been sourced from reputable journals and databases. The findings of all studies relate well with what I encounter in daily training among the selected population.
Most importantly, I have included current studies that are less than five years old. This makes my sources reliable for application in my current training and future practice. The conclusion of systematic reviews in my problem assessment adds a great value to the validity and reliability of the findings in my analysis due to their high level of evidence. I used only one website to assess the health problem. The website is scholarly because it is managed by CDC, which is a government organization because the universal reference link ended with .gov
The Impact of State Board Nursing Practice Standards and Government Policies
Governance of health regulates the delivery of healthcare interventions and how patients seek care. On the other hand, state board standards regulate nursing practices at the state level that determine how nurses offer care and aim at protecting the public (Torrens et al., 2020). As aforementioned, multiple chronic diseases can be present in one patient, which worsens the outcomes.
Current health policies such as the affordable care act aimed at improving coverage and discouraged insurance companies from denying patients with chronic diseases insurance coverage at subsidized rates. Government policies can affect access or care for patients with diabetes mellitus, especially African Americans who have additional health disparities.
Nurses can offer better patient education and diabetes management interventions, but state and federal policies can limit their performance and care outcomes (Nikitara et al., 2019; Alshammari et al., 2021). The policies should support both the patients and the nurses in the care process
Primary care is essential for diabetes management, monitoring, and follow-up. Nurses in primary care settings, therefore, need to have adequate knowledge to enable them to offer culturally sensitive patient education. Most state boards of nursing standards require nurses to practice to the full extent of their education and training. Therefore, the nurses get full practice authority that enables them to offer treatment as well as patient education. However, this privilege is limited in some states by the state boards.
In these cases, nurses cannot prescribe medical treatment independently for patients with diabetes. Therefore, state boards’ regulations can greatly affect how diabetes is managed among patients with risks of the disease. Limitations in the workforce worsen the situations where practice scope for nurses is reduced or limited.
Leadership Strategies to Improve Outcomes and Care Quality in Diabetes Management
Diabetes management requires a multidisciplinary approach to ensure the best outcomes. Key stakeholders such as patients, their families, family caregivers, nurses, endocrinologists, dieticians, state-based policymakers, and other healthcare specialists must be involved in the management.
Participative leadership and policy-making are key strategies that would improve patient outcomes and patient-centered care. When the patients are involved in their care, the healthcare providers can target their interventions to meet patients’ needs rather than the needs at the group level. Bringing together the above stakeholders may not be enough. Their participation can be greatly contributory to the final patient care outcomes. This participative approach requires good care coordination (Asif et al., 2019).
Best coordination in diabetes management can be provided by nurses, thus their essentiality in diabetes care. Nurses’ participative leadership will ensure patient satisfaction and improve their adherence and positive behavior change toward disease prevention (Nikitara et al., 2019). This is because the multidisciplinary approach contribution will be goal-oriented and focused on meeting patient needs.
Patient care communication will also be essential for the success of this participative approach. As the chief coordinator, the nurse should communicate the best care plans effectively and collaborate with all stakeholders. To this population, the nurse needs to be involved positively in policy-making and influence policies that will encourage access and eliminate health disparities where possible.
Planning and communication of change will be the best change management strategy that will improve care outcomes (Asif et al., 2019). Therefore, communication, collaboration, coordination, and active participation are essential leadership strategies that will ensure high-quality patient-centered care.
The health problem in this capstone problem is diabetes mellitus type 2 among adult African Americans. I selected this population because of the documented evidence of the high prevalence of diabetes among this group. Literature evidence has attributed this health problem to the selected propagation with health disparities and other determinants of health such as culture, genetics, health literacy, and health-seeking behavior.
The sources used were of good quality and value to assess the problem. Policies at the local, state, and federal levels impact diabetes management indirectly by impacting the scope of nursing practice, access to care, and addressing health disparities. Therefore, nurses require participative leadership as a strategy to address this health problem through policy making, communication, collaboration, and coordination.
Ajuwon, A. M., & Love, R. (2020). Type 2 diabetes and depression in the African American population. Journal of the American Association of Nurse Practitioners, 32(2), 120–127. https://doi.org/10.1097/JXX.0000000000000240
Alshammari, M., Windle, R., Bowskill, D., & Adams, G. (2021). The role of nurses in diabetes care: A qualitative study. Open Journal of Nursing, 11(08), 682–695. https://doi.org/10.4236/ojn.2021.118058
Ard, D., Tettey, N.-S., & Feresu, S. (2020). The influence of the family history of type 2 diabetes mellitus on positive health behavior changes among African Americans. International Journal of Chronic Diseases, 2020, 8016542. https://doi.org/10.1155/2020/8016542
Asif, M., Jameel, A., Sahito, N., Hwang, J., Hussain, A., & Manzoor, F. (2019). Can leadership enhance patient satisfaction? Assessing the role of administrative and medical quality. International Journal of Environmental Research and Public Health, 16(17), 3212. https://doi.org/10.3390/ijerph16173212
CDC. (2022, January 24). The facts, stats, and impacts of diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/spotlights/diabetes-facts-stats.html
Ellis, K. R., Hecht, H. K., Young, T. L., Oh, S., Thomas, S., Hoggard, L. S., Ali, Z., Olawale, R., Carthron, D., Corbie-Smith, G., & Eng, E. (2020). Chronic disease among African American families: A systematic scoping review. Preventing Chronic Disease, 17(190431), E167. https://doi.org/10.5888/pcd17.190431
Hu, J., Mion, L. C., Tan, A., Du, Y., Chang, M.-W., Miller, C., & Joseph, J. J. (2021). Perceptions of African American adults with type 2 diabetes on family support: Type, quality, and recommendations. The Science of Diabetes Self-Management and Care, 47(4), 302–311. https://doi.org/10.1177/26350106211018994
Hurt, T. R., Francis, S. L., Seawell, A. H., Krisco, M. P., Flynn, M. H., O’Connor, M. C., Rudolph, C. S., & Hill, A. (2020). Revising diabetes programming for black men and their families. Global Qualitative Nursing Research, 7, 2333393620960183. https://doi.org/10.1177/2333393620960183
King, C. J., Moreno, J., Coleman, S. V., & Williams, J. F. (2018). Diabetes mortality rates among African Americans: A descriptive analysis pre and post-Medicaid expansion. Preventive Medicine Reports, 12, 20–24. https://doi.org/10.1016/j.pmedr.2018.08.001
Nikitara, M., Constantinou, C. S., Andreou, E., & Diomidous, M. (2019). The role of nurses and the facilitators and barriers in diabetes care: A mixed-methods systematic literature review. Behavioral Sciences, 9(6), 61. https://doi.org/10.3390/bs9060061
Shiyanbola, O. O., Ward, E., & Brown, C. (2018a). Sociocultural influences on African Americans’ representations of type 2 diabetes: A qualitative study. Ethnicity & Disease, 28(1), 25. https://doi.org/10.18865/ed.28.1.25
Shiyanbola, O. O., Ward, E. C., & Brown, C. M. (2018b). Utilizing the common-sense model to explore African Americans’ perception of type 2 diabetes: A qualitative study. PloS One, 13(11), e0207692. https://doi.org/10.1371/journal.pone.0207692
Skrine Jeffers, K., Cadogan, M., Heilemann, M. V., & Phillips, L. R. (2019). Assessing informal and formal diabetes knowledge in African American older adults with uncontrolled diabetes. Journal of Gerontological Nursing, 45(2), 35–41. https://doi.org/10.3928/00989134-20190111-06
Torrens, C., Campbell, P., Hoskins, G., Strachan, H., Wells, M., Cunningham, M., Bottone, H., Polson, R., & Maxwell, M. (2020). Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: A scoping review. International Journal of Nursing Studies, 104(103443), 103443. https://doi.org/10.1016/j.ijnurstu.2019.103443
Leadership Collaboration Communication Change Management and Policy Considerations Instructions
- In a 5–7 page written assessment, define the patient, family, or population health problem that will be the focus of your capstone project. Assess the problem from a leadership, collaboration, communication, change management, and policy perspective. Plan to spend approximately 2 direct practicum hours meeting with a patient, family, or group of your choice to explore the problem and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
- This assessment lays the foundation for the work that will carry you through your capstone experience and guide the practicum hours needed to complete the work in this course. In addition, it will enable you to do the following:
- Develop a problem statement for a patient, family, or population that’s relevant to your practice.
- Begin building a body of evidence that will inform your approach to your practicum.
- Focus on the influence of leadership, collaboration, communication, change management, and policy on the problem.
- In this assessment, you’ll assess the patient, family, or population health problem that will be the focus of your capstone project. Plan to spend approximately 2 hours working with a patient, family, or group of your choice to explore the problem from a leadership, collaboration, communication, change management, and policy perspective.During this time, you may also choose to consult with subject matter and industry experts about the problem (for example, directors of quality or patient safety, nurse managers/directors, physicians, and epidemiologists).
- To prepare for the assessment, complete the following:
- Identify the patient, family, or group you want to work with during your practicum The patient you select can be a friend or a family member. You’ll work with this patient, family, or group throughout your capstone project, focusing on a specific health care problem.
- Begin surveying the scholarly and professional literature to establish your evidence and research base, inform your assessment, and meet scholarly expectations for supporting evidence.
- In addition, you may wish to complete the following:
- Review the assessment instructions and scoring guide to ensure that you understand the work you’ll be asked to complete and how it will be assessed.
- Practicum Focus Sheet: Assessment 1 [PDF]
- Download Practicum Focus Sheet: Assessment 1 [PDF], which provides guidance for conducting this portion of your practicum.
- Note: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.
- Complete this assessment in two parts.
- Define the patient, family, or population health problem that will be the focus of your capstone project. Assess the problem from a leadership, collaboration, communication, change management, and policy perspective and establish your evidence and research base to plan, implement, and share findings related to your project.
- Connect with the patient, family, or group you’ll work with during your practicum. During this portion of your practicum, plan to spend at least 2 hours meeting with the patient, family, or group and, if desired, consulting with subject matter and industry experts of your choice. The hours you spend meeting with them should take place outside of regular work hours. Use the Practicum Focus Sheet [PDF] provided for this assessment to guide your work and interpersonal interactions. Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
- The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.
- Define a patient, family, or population health problem that’s relevant to your practice.
- Summarize the problem you’ll explore.
- Identify the patient, family, or group you intend to work with during your practicum.
- Provide context, data, or information that substantiates the presence of the problem and its significance and relevance to the patient, family, or population.
- Explain why this problem is relevant to your practice as a baccalaureate-prepared nurse.
- Analyze evidence from peer-reviewed literature and professional sources that describes and guides nursing actions related to the patient, family, or population problem you’ve defined.
- Note whether the authors provide supporting evidence from the literature that’s consistent with what you see in your nursing practice.
- Explain how you would know if the data are unreliable.
- Describe what the literature says about barriers to the implementation of evidence-based practice in addressing the problem you’ve defined.
- Describe research that has tested the effectiveness of nursing standards and/or policies in improving patient, family, or population outcomes for this problem.
- Describe current literature on the role of nurses in policy making to improve outcomes, prevent illness, and reduce hospital readmissions.
- Describe what the literature says about a nursing theory or conceptual framework that might frame and guide your actions during your practicum.
- Explain how state board nursing practice standards and/or organizational or governmental policies could affect the patient, family, or population problem you’ve defined.
- Describe research that has tested the effectiveness of these standards and/or policies in improving patient, family, or population outcomes for this problem.
- Describe current literature on the role of nurses in policy making to improve outcomes, prevent illness, and reduce hospital readmissions.
- Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of this problem.
- Propose leadership strategies to improve outcomes, patient-centered care, and the patient experience related to the patient, family, or population problem you’ve defined.
- Discuss research on the effectiveness of leadership strategies.
- Define the role that you anticipate leadership must play in addressing the problem.
- Describe collaboration and communication strategies that you anticipate will be needed to address the problem.
- Describe the change management strategies that you anticipate will be required to address the problem.
- Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
- Organize content so ideas flow logically with smooth transitions.
- Apply APA style and formatting to scholarly writing.
- Format: Format your paper using APA style. APA Style Paper Tutorial [DOCX] is provided to help you in writing and formatting your paper. Be sure to include:
- A title page and reference page. An abstract is not required.
- Appropriate section headings.
- Length: Your paper should be approximately 5–7 pages in length, not including the reference page.
- Supporting evidence: Cite at least five sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.
- Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on its substance.
- Complete the NURS-FPX4900 Volunteer Experience Form in Capella Academic Portal. Include a description of your relationship to the patient, family, or group in the Volunteer Experience comments field.
- The BSN Capstone Course (NURS-FPX4900 ) requires the completion and documentation of nine (9) practicum hours. All hours must be recorded in the Capella Academic Portal. Please review the BSN Practicum Campus page for more information and instructions on how to log your hours.
- Nurses in all professional roles work to effect positive patient outcomes and improve organizational processes. Professional nurses are leaders in problem identification, planning, and strategy implementation—skills that directly affect patient care or organizational effectiveness.
- Too often, change agents jump to a conclusion that an intervention will promote the envisioned improvement. Instead, the ideal approach is to determine which interventions are appropriate, based on an assessment and review of credible evidence. Interventions could be patient-facing or involve a change in policy and process. In this assessment, you’ll identify and make the case for your practicum focus area, then explore it in depth from a leadership, collaboration, communication, change management, and policy perspective.
- By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
- Competency 1: Lead people and processes to improve patient, systems, and population outcomes.
- Define a patient, family, or population health problem that’s relevant to personal and professional practice.
- Competency 2: Make clinical and operational decisions based upon the best available evidence.
- Analyze evidence from peer-reviewed literature and professional sources that describes and guides nursing actions related to a defined patient, family, or population problem.
- Competency 5: Analyze the impact of health policy on quality and cost of care.
- Explain how state board nursing practice standards and/or organizational or governmental policies could affect a defined patient, family, or population problem.
- Competency 7: Implement patient-centered care to improve quality of care and the patient experience.
- Propose leadership strategies to improve outcomes, patient-centered care, and the patient experience related to a defined patient, family, or population problem and document the practicum hours spent with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
- Competency 8: Integrate professional standards and values into practice.
- Organize content so ideas flow logically with smooth transitions.
- Apply APA style and formatting to scholarly writing.