Picot statement is one of the tools used in nursing to help nurses and medical researchers come up with answerable research quitting whose essence is to find factual and evidence-based answers to existing health problems. As previously highlighted in assessment two within the picot statement developed to provide answers to the best and most effective interventions for the management of debates among older adults, it is worth rephrasing the same picot statement as it contains not only answerable research questions but also provided a well-elaborated picture of the suggested diabetes management strategies using non-pharmacotherapeutic approaches in comparison with insulin administration (Akinlua, 2013). The intervention designs for the management of diabetes will be composed of patient education on weight loss and weight management, the creation of awareness on risk factors for diabetes, and a smoking cessation program as the basis for minimizing obesity risk for cardiovascular disease and diabetes (Akinlua, 2013). Also, physical activities, including cycling, swimming, and daily morning runs, will be implemented as critical interventions for treating and managing diabetes.
The picot statement presented in the previous assessment reads as shown below;
In older adults above 55 years, (P) will educate on weight loss and weight management programs using strategies such as dietary restriction, meal portioning, smoking cessation, limiting alcohol, and active engagement in physical exercises via patient monitoring and follow-ups using supervised treatment with the aid of various telehealth technologies (I) in monitoring diabetes symptoms be more effective in treatment and management of diabetes compared to insulin administration (C) which aims at minimizing diabetes-related health impacts (O) within five months (T?
From the above picot statement, it can be noted that the primary target of this project is to leverage non-pharmacological interventions to help geriatrics with diabetes effectively treat a control symptom associated with diabetes and perhaps prevent potential complications that may give rise to deterioration of their health (Akinlua, 2013). Among the critical components of the suggested treatment options for diabetes are the following: Weight loss and weight management program, dietary restrictions, and use of physical activities such as isometric and aerobic exercises to promote better management of overweight and obesity-related issues, which are critical predisposing factors to the development of diabetes among seniors aged 65 years and above. Additionally, the proposed interventions for geriatric diabetes management include patient education on utilizing various mobile-based applications to monitor, record, and share diabetes symptoms with primary caregivers and self-manage them. Besides that, the interventions also seek to empower diabetic patients through sensitization and creating awareness of health challenges that come with a sedentary lifestyle (Akinlua, 2013). Note that this project is guided by the picot question or statement presented earlier and in previous assessments. Having understood the highlighted critical components of the suggested interventions for the management of diabetes, let us look at the extensive explanation of the justification of the benefits and efficacy of each of the components stated earlier.
Patient assessment for other underlying health conditions and the presence of risk factors for diabetes offers an excellent platform for discussion and engagement of patients in developing a patient-centered care approach. In this project, diabetic patients will be grouped into various groups for easy customization of treatment plans that best meet the health needs of each patient in each group (Akinlua, 2013). Note that for overweight patients and those with obesity issues, weight loss, and weight management programs will be among the most effective interventions to help them control diabetes symptoms. According to the American Diabetes Association (ADA), weight management can effectively treat and manage diabetes (Lo, 2023). This organization provides that to achieve better weight loss and management, overweight and obese patients who have diabetes ought to take diets with energy deficiency of about 500 to 700/kcal/d. Also, a World Health Organization survey conducted on the importance of weight loss and weight management among diabetic patients contributes to the progressive improvement of insulin response to blood sugar, thereby promoting better control and management of diabetes symptoms. Diet restrictions and engagement in physical activities can effectively manage diabetes (Lo, 2023). Patient with severe overweight issues will also be educated and sensitized on the best local community resources that will empower them to self-manage their weight. Among these resources are the Weight Watchers Points Program, rated number 1 in United States News and the World Report of 2023. This program helps weight patients understand what they are eating by assigning every food number concerning the calories the food contains and other elements such as sugar level, fiber, proteins, and the amount of saturated or unsaturated fats (Lo, 2023). In this program, obese patients will get personalized points budget on food expenditure to help them effectively track what they eat in an app.
Smoking cessation can be achieved via several methods, including self-help programs that provide them with reading materials on the health impacts of smoking, along with interventions that can be adopted to minimize nicotine cravings (Lo, 2023). The other approach is the use of nicotine replacement therapy, where patients will be provided with a nicotine patch of chewing gums that gradually minimizes the urge to smoke and helps patients effectively manage withdrawal symptoms.
Patients with diabetes must be educated on the types and amounts of foods to eat and the foods to avoid. This can be achieved through the implementation of Mediterranean diets. Note that many times, encouraging diabetic patients to adhere to an appropriate diet may be challenging and perhaps impair effects to help patients minimize the progression and worsening of diabetes symptoms. Nevertheless, using mobile-based tips and guidelines on what to eat or discard from diets can effectively train diabetic patients on the diets to adhere to (Lo, 2023). At the time of assessment and diagnosis, it will be highly recommended that diabetic patients with obesity be referred to a registered dietitian (Packer et al., 2019). American Diabetes Association provides that implementation of diabetes-specific MNT helps older adults at risk of diabetes have better glycemic control and improved management of diabetes complications.
Behavioral, cognitive therapy and counseling sessions will be employed to educate patients on how to avoid thoughts and behaviors that increase the urge for alcohol. Quitting alcohol helps diabetes patients maintain half weight, a strategy that promotes better management, prevention, and delay of type 2 diabetes for vulnerable patients (Packer et al., 2019). Quitting alcohol also helps in improving the body’s sensitivity, an aspect that delays the development of type 2 diabetes.
Aerobic and isometric physical activities are essential for people with disputes to improve blood sugar management. Some of the physics activities diabetic patients should be involved in to manage blood sugar levels are engaging in morning runs for at least 30 minutes daily or four times a week. Studies by the CDC have shown that active engagement in isomeric and aerobic exercise contributes to better management of des through by promoting weight loss and reduced risk for cardiovascular disease. Isomeric and aerobic exercises help minimize a sedentary lifestyle. The patient’s age, current activity levels, and existing diabetes-related complications should be considered (Packer et al., 2019).
The aging population or older adults have several health challenges. This population is characterized by numerous health and social challenges impacting their lives. The population is characterized by mental illnesses such as dementia, sensory impairment, and insulin resistance, which results in diabetes, physical impairment, and pain communication issues. Some of the cultural needs of the population that will impact this project are religious faith and beliefs in the use of technology to provide efficient care services. People with strong religious faith and beliefs will often oppose the use of technology and other pharmacological interventions in the management of chronic diseases like diabetes. Also, cultural issues associated with language barriers, norms, and values of various types of food may influence the efforts to promote a change in diet and sedentary lifestyle (Quan & Ng, 2021). This will be challenging when suggesting some food that should be included or discarded for individuals with diabetes. It will also affect the type of exercises such older adults will engage in, as some exercises may not be acceptable for older adults based on their cultural beliefs and norms. Impaired communication and language barriers are also significant cultural needs and characteristics of the odder idler that will impact the project. Using medical nurse interpreters will lessen its impact.
The theoretical framework is the basis for any research as it provides background over which study findings can be based and applied in practical shape. In this project, the basis for this research and application of various components of the suggested interventions in the management of diabetes will be Orem’s Self-Care Deficit Theory, together with Sister Callista Roy’s Theory of Adaptation. Orem’s Self-Care Deficit Theory fits the project because it advocates for self-care as a human regulatory function that should be embraced when developing treatment plans for diabetes patients. This theory will be vital for the project in devising interventions that are focused on educating diabetic patients on the essence of self-efficacy in the management of diabetes symptoms using non-pharmacological approaches such as minimizing sedentary lifestyles and utilization technologies that have been approved in promoting self-monitoring of blood sugar in real-time (Packer et al., 2019). These technologies include blood sugar meters and continuous glucose monitoring systems like the Freestyle Libre and Dexcom G6. The relevance of Orem’s Self-Care Deficit Theory in this project will provide the basis for the establishment and provision of patient education that improves their awareness of risk factors for diabetes to sensitize them on activities they need to initiate and perform to promote self-efficacy in maintaining a healthy life and well-being (Packer et al., 2019). Using Orem’s Self-Care Deficit Theory in combination with Sister Callista Roy’s model, nurses working with diabetic patients assess and identify the aspect of patient care concerning the patient’s capacity to embrace self-efficacy in the management of diabetes to facilitate the development of a care plan that best suits their patients.
The primary stakeholders will be patients, nurses, pharmacists, nurse informaticists, patients’ families, mental healthcare providers, and registered dietitians. Family and patients will actively be engaged in decision-making on the most appropriate treatment and care that best meets their health and cultural needs. The essence of nurses is to work with dietitians after patient assessment and diagnosis to establish an eating plan along with serving diabetic patients to minimize weight gain and exacerbation of health issues such as type 2 diabetes and issues of high blood pressure (Quan & Ng, 2021). Nurse informaticists, in collaboration with other nurses, will assess and identify the most effective, FDA-approved, and secure mobile-based technologies for monitoring and guiding diabetic patients on the best practices for initiating programs to promote better ways of dealing with diabetes and other an aspect of health issues. Also, policy developers associated with patient data protection can be included in developing therapies for treating diabetes (Quan & Ng, 2021). This stakeholder will help highlight and educate nurses and patients on using various technologies to facilitate efficiency and less costly care services. The policy and regulations that aid in providing care services to diabetes using CGMs and mobile-based applications.
The healthcare policy that will impact the project is the Affordable Care Act. Provisions such as the Access and Care Act (H.R. 2651), Protecting Access to Diabetes Supplies Act (H.R. 771), and Medicare CGM Access Act (H.R. 1427) are among the regulations that impact the provision of equitable, quality, cost-effective and accessible healthcare services diabetic patients (Quan & Ng, 2021). The Medicare CGM Access Act (H.R. 1427) created a new benefit for people with diabetes who receive Medicare services to receive services such as continuous glucose monitoring devices. This will support the project’s interventions geared towards promoting telehealth technologies in empowering patients to become more effective in self-monitoring their symptoms (Quan & Ng, 2021). As one of the key regulations and policies in the healthcare sector, the Access and Care Act (H.R. 2651) will be employed to ensure that minority communities and most affected populations, particularly older adults, will get easy access to services provided by the CDC which includes prevention, treatment and public education on how to curb risk factors associated with diabetes. This will contribute positively to the project’s development and achieving desired outcomes.
The ethical implication of the suggested interventions revolves around patient anatomy, beneficence, and non-maleficence. According to nursing standards and ethical principles for the provision of safe and quality healthcare services, it is good to note that when dealing with geriatric suffering from chronic health challenges such as diabetes, patients and family input in decision-making about care and treatment plans should be made paramount. Patient autonomy is essential as it allows nurses and patients to work conjointly in developing customized care plans (Thirunavukkarasu Sathish et al., 2021). This aspect minimizes miscommunication and promotes time information sharing, vital in developing patient care plans (Quan & Ng, 2021). The principles of non-maleficence and beneficence will also be essential to consider when selecting treatment approaches, as these principles restrict nurses from prioritizing patient health needs and interests above everything else. By doing so, nurses will minimize engaging in practices that may harm and injure their patients (Quan & Ng, 202). One of the relevant legal issues related to the project is using patient data and the sharing of the data through electronic devices. This will be implemented through the provisions of the HIPAA privacy policy, which will act as the reference point for protecting and securing patient data from malicious parties. The regulations provided by HIPAA will provide tips on how nurses should use technology to offer cost-effective, secure, and efficient healthcare services.
In summary, smoking cessation programs such as nicotine replacement therapy, self-help efforts, use of community resources such as online and web resources for diabetes education, dietary restriction accompanied with meal portioning, and utilization of CGMs and other blood sugar monitoring apps will be critical components for the interventions designed for treatment and management of diabetes.
Akinlua, O. (2013). The glycemic index of selected Nigerian foods for apparently healthy people. Journal of Obesity & Weight Loss Therapy, 03(01). https://doi.org/10.4172/2165-7904.1000160
Lo, K. (2023). Review for “Impact of weight loss and weight gain trajectories on body composition in a population at high risk of type 2 diabetes: A prospective cohort analysis”. https://doi.org/10.1111/dom.15400/v2/review2
Packer, R., Ben Shlomo, Y., & Whiting, P. (2019). Can non-pharmacological interventions reduce hospital admissions in people with dementia? A systematic review. PLOS ONE, 14(10), e0223717. https://doi.org/10.1371/journal.pone.0223717
Quan, J., & Ng, C. (2021). The burden of inadequately controlled risk factors for type 2 diabetes in Hong Kong: A population-based modeling study. https://doi.org/10.26226/morressier.617c37317c09fc044a975232
Thirunavukkarasu Sathish, Robyn J. Tapp, & Jonathan E. Shaw. (2021). Author response to “Do lifestyle interventions reduce diabetes incidence in people with isolated impaired fasting glucose?”. https://doi.org/10.1111/dom.14529/v2/response1