NRS 428 CLC – Evidence-Based Practice Project Intervention Presentation on Diabetes

The use of mobile phone-based monitoring management systems are effective for patients to self manage blood glucose levels. In the research analysis, the phone app was called Hicare smart K, Insung information. This app was used as a daily tracker for 3 months. The app itself was interactive and user friendly for all age groups. The mobile phone app method was simpler for both patient and physician to record and read blood glucose levels. It required the patient to do their own blood glucose checks and then manually input the readings into the app where it was linked to the hospital for recording (Yang et al., 2020).

The population that was of interest in this research were middle and late adulthood age groups. There were 4 individuals that were younger than 40 years old. Next, there were 36 individuals between 40-60 years of age. Also, 57 individuals were either 60 years of age or older. From this group, 45 patients were male and 52 were female. The patients mentioned were part of the control group with no intervention of mobile phone apps. They were all patients who had type 2 diabetes (Yang et al., 2020).

The population that was the intervention group in this research were also middle and late adulthood age groups. There were 10 individuals that were younger than 40 years old. Also, there were 93 individuals between 40-60 years of age. Next is 47 individuals that were either 60 years of age or older. In this group, 80 patients were males and 70 were female. This group had the mobile phones app and were all type 2 diabetic patients (Yang et al., 2020).

A mobile phone-based glucose-monitoring and feedback system for the treatment of type 2 diabetes mellitus (T2DM) is a promising new technology that has yet to be fully evaluated. Clinical studies have shown that the use of such a system leads to improved glycemic control, as well as increased patient satisfaction and engagement (Yang et al., 2020). In addition, mobile phone interventions may help to reduce healthcare costs by allowing patients to monitor their own blood sugar levels and provide feedback to their physician. While further research is needed to confirm the long-term benefits of mobile phone-based glucose monitoring, this technology shows great promise for the treatment of T2DM. A mobile phone–based glucose-monitoring and feedback sys

tem (MP-GMS) was developed to improve diabetes management in multiple primary care clinic settings. The system was implemented in three waves of clinic randomized trials. Wave 1 clinics (N=6) were randomized to either the MP-GMS or usual care. Wave 2 clinics (N=5) were randomized to the MP-GMS with additional support from a trained clinical research coordinator (CRC), or usual care. Wave 3 clinics (N=4) were randomized to the MP-GMS with or without an accompanying group education program. The electronic medical records of all participants in all three waves were analyzed (Yang et al., 2020).

The study found that patients with a higher baseline HbA1c levels showed a greater significant impact on glycemic control. In other words, those with worse blood sugar control to begin with saw more improvement in blood sugar control when they added liraglutide to their treatment plan. This finding underscores the importance of early intervention and aggressive m

anagement of diabetes in order to achieve the best possible outcomes. The HbA1c test is a key tool used by healthcare professionals to help manage diabetes. This test measures the level of glycated hemoglobin in the blood, which gives an indication of how well your diabetes is being controlled over time. There are a number of different target HbA1c levels that may be recommended for people with diabetes, depending on individual circumstances. A higher target may be advised for people with a history of serious hypoglycemic episodes, or those who are pregnant. For most people with diabetes, the aim is to keep their HbA1c levels below 7% (Yang et al., 2020).

A mobile phone-based glucose monitoring and feedback system can be a great asset in primary care

clinic settings. By providing real-time data and feedback to patients, this type of system can help them better manage their diabetes. In addition, the ability to share data with providers can help clinics identify patterns and potential areas for improvement. When used in conjunction with traditional medical care, a mobile phone-based glucose monitoring system can be a powerful tool for improving diabetes management. A clinic setting is the ideal environment for a mobile phone-based glucose monitoring and feedback system. In a primary care setting, nurses or other health professionals can provide patients with real-time feedback on their blood sugar levels, as well as educational information about diabetes and its management. A mobile phone-based glucose monitoring and feedback system has the potential to improve glycemic control in patients with diabetes, thereby reducing the risk of long-term complications. In addition, such a system could help to reduce the burden on healthcare professionals, who are often responsible for providing patient education about diabetes self-management (Yang et al., 2020).

Smartphone technology has proven to be beneficial in diabetic management due to the consistency of

NRS 428 CLC Evidence Based Practice Project Intervention Presentation on Diabetes

tracking and communication with primary care physicians for consistent feedback. In this study it was found that younger patients had better outcomes when using smartphone technology to manage their diabetes, (Yang et al., 2020) which could be connected to their generational experience with technology. As technology improves and upcoming generations with diabetes learn smartphone-based monitoring, they will be better skilled with technology prior to diagnosis. This prior understanding of technology will be a benefit to diabetes smartphone management. This technology will speed up the response for providers to intervene with patient needs when not in a clinical setting (Bauer & Bodenheimer, 2017).

Smartphone technology in this study relates to nursing in that the information submitted is sent directly to the patient’s primary care physician where nursing care also takes place. As time progresses nursing continues to have a larger role in the primary care setting and has proven improved care for patients managing chronic disease such as diabetes, (Bauer & Bodenheimer). In the clinical setting nursing has the opportunity to access patient information from an online portal to assess and intervene in the daily blood glucose management reports. Nursing has the skills to monitor for signs that the patient needs further education, medications, or a quicker response from the physician (Bauer & Bodenheimer, 2017). .

The beginning use of any medical phone application starts with education in a clinical setting. Nursing has a large responsibility in teaching patients about their plans of care. Smartphone use in navigating health care has become an efficient way to gather information and communicate, (de Jong et al., 2020). Smartphone use in the medical field has continued to grow with the growth of professional medical applications to improve care, (de Jong et al., 2020). This application can be considerate of cultural and spiritual needs of the patient by utilizing preferred settings or having back-up systems when the patient cannot use technology certain days such as holy days. Assisting the patient in its use and building confidence will address the patient’s psychological needs as diabetes management can cause a lot of anxiety before adding in new technology.

Building trust in technology requires experiences that prove its effectiveness. Nursing can teach patients how an application works and why it is beneficial. In the meantime, nurses can encourage the patient to use a previously trusted monitoring system while they learn the smartphone application to build confidence in its potential benefit. Nurses should also prepare patients with troubleshooting when the application is not functioning properly or has an upgrade that requires it to be inactive. This can help a patient feel more independent in their diabetes management. Last in building trust the nurse can provide multiple points of research and statistics that support the use of a smartphone application for diabetes management.
The patient needs supported in their education of smartphone application use. Depending on the age or culture of a patient they may need more or less guidance on how to navigate a new application. The nurse should emphasize the application’s use, features, settings, and how to communicate with the medical team in real time.One of the hardest parts of diabetes management is that a patient’s blood glucose is constantly changing, and the patient may not know that their sugar level is becoming too high or too low until they become symptomatic. This could have been negated with an alert from a smartphone. This technological data can then also be sent to a physicians and nursing in real time (Yang, et al., 2020).
- Nursing could also be updated to check on a patient’s well-being if their sugar drops too low or to alert emergency help. The nurse can make a phone call or text to check on the patient per their preference. Some patients may want more interaction than others and this could be modified according to their wishes
- Resources could be generated in a smartphone application so the patient can access help when needed such as a medical facility or a convenient store for sugar. Prior to the application being used, a nurse can ensure a patient has a plan for when they do need to get help with a critical low or high blood sugar. This real time application could also help the patient find pharmacies with medication and supplies.
- When a patient has a critical blood sugar which would be relayed to the medical providers with updated patient information. Nursing or other staff could help activate emergency response to the patient based on their GPS location.
Since technology is constantly evolving and improving the application can be used for ongoing medical help for the patient managing diabetes. Currently nurses refer to personal smartphones for updated education regarding their own practice and for patient education, (de Jong et al., 2020). This instant information upload can be applied in a smartphone application to help patients receive immediate informational help in their ongoing care.
- Nursing can send educational updates on diabetes management, nutritional education, new studies, support groups, and social media links directly to the patient’s smartphone through a safe application. These resources support the patient physically by addressing the disease and management through nutrition. The patient can be supported culturally and spiritually by sending information that pertains to their culture. For example. new diabetes friendly recipes for the patient who does not eat meat can help a patient feel supported while addressing their disease.
- Like technology, medication evolves and with a patient improving or progressing in disease, medication adjustments or new medications might be necessary in their treatment. In this application a nurse can update a patient on what their new medication regimen should be and provide a clear message on rationale along with a place to communicate questions. Medication recalls could also be updated on the application so the patient gets information instantly so they can change their regimens.

As previously mentioned, the application should have a place where a patient can connect with a nurse with questions regarding their healthcare. This could be a text interface or a link for a phone number. This provides a patient with quick responses to questions without waiting for a doctor appointment.

Psychological factors should be handled or considered when handling diabetes care. The following are the reasons. The first reason is that psychological help promotes stress management in patients which is important in diabetes care (Kalra et al., 2018). Stress leads to poor adherence to medications. When patients develop a good attitude and are positive, they adhere to treatment guidelines and they become more proactive in self care. A patient’s mental status affect their relationships with family and providers (Kalra et al., 2018). A good attitude to providers leads to better experience of care. The importance of a good mental status is reaffirmed by the fact that diabetes patients need resilience to be able to manage the disease throughout their lives (Kalra et al., 2018). Fatigue and despair can arise and to be able to gather strength to continue managing the disease, their mental status needs to be good.

The culture of a patient and their spirituality also plays a role in the outcomes of diabetes care. Nutrition and diet is often shaped by culture. Culture can impact whether a person embraces modern healthcare. Some cultures prefer traditional medicine over modern medicine (Caballero, 2018). Culture also influences the level of family involvement in patient care. Some cultures necessitate that consultation are made to even extended family members (Caballero, 2018). Finally, culture is associated with language. Providers would achieve better result if they communicate with patients in their native languages. Spirituality influences care outcomes as follows. Spirituality is a source of moral support. A patient can rely on spirituality to find purpose in life and hope. Spiritual activities also bring people together which is an opportunity for gathering social support (Caballero, 2018).

To provide care that accommodates spirituality, culture and a patient’s psychology, the following are the strategies. The first is working with a patient’s family (Caballero, 2018). The family can provide ideas on how to improve care in consideration of the three aspects. The next is engaging the faith leaders of a patient. The care plan should consider a patient’s race and native language. The lead providers should engage social workers and community health workers. Mental health providers should be part of the care team (Caballero, 2018). Finally, the care team should be trained how to provide culturally competent care.

References

¡Bauer, L., & Bodenheimer, T. (2017). Expanded roles of registered nurses in primary care delivery of the future. Nursing outlook, 65(5), 624-632.

¡Caballero, A. E. (2018). The “A to Z” of managing type 2 diabetes in culturally diverse populations. Frontiers in endocrinology, 9, 479. Doi: 10.3389/fendo.2018.00479

¡de Jong, A., Donelle, L., & Kerr, M. (2020). Nurses’ use of personal smartphone technology in the workplace: Scoping Review. JMIR mHealth anduHealth, 8(11), e18774. https://doi.org/10.2196/18774

¡Kalra, S., Jena, B. N., & Yeravdekar, R. (2018). Emotional and psychological needs of people with diabetes. Indian journal of endocrinology and metabolism, 22(5), 696.

Yang, Y., Lee, E. Y., Kim, H. S., Lee, S. H., Yoon, K. H., & Cho, J. H. (2020). Effect of a Mobile Phone-Based Glucose-Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial. JMIR mHealth and uHealth, 8(2), e16266. https://doi.org/10.2196/16266

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