Case Study: Promoting Self- Management of Chronic Illness in a Patient-Centered World Problem

Case Study: Promoting Self- Management of Chronic Illness in a Patient-Centered World Problem

Not only does patient noncompliance affect the United States as a whole, noncompliance lurks within the community served. Statistical reports, over the past six months, revealed 63% of the diabetic patient population served by ABC Community Health Clinic sustained a Hg A1C greater than 8%. As a nurse leader/manager, I investigated the cause in the inability to promote patient compliance. Individual staff interviews disclosed possible factors leading to poor diabetes control. The RNs and NPs blamed the lack of time and mere frustration brought on attempting to care for individuals lacking responsibility for their personal health care. The physicians’ concerns lie within their patient liability and are refusing to order blood glucose monitoring during routine appointments since the results are predictable. The physician feels coerced into treating an unmanageable patient. 79 Addressing the Problem Patient-centered care fosters a partnership between the patient and medical practitioner for coordination of care through orchestrating health care coordination amongst members of the patient's health care team, involving the patient and family, and encouraging self-management of one's personal health care (Saha, Beach, & Cooper, 2008). This approach promotes quality, safety, efficiency, and eliminates gaps in health care. As the organization moves toward patientcenteredness, the direct-care RNs undertook a team approach to improve T2DM compliance. A goal to improve compliance by 25% within six months reflected in improved Hg A1C results of less than 8%. The team was allotted 30 minutes following lunch for brainstorming sessions and the development of practice changes. Results Extended appointment times designated for T2DM patients, focusing on the patient, listening to concerns, identifying barriers discussing risks and benefits to compliance. Free and low cost medication websites were made available if finances cause concern (Kocurek, 2009). A blood glucose diary provided will attest daily compliance with a predetermined schedule for testing. The American Diabetes Association provided resources for living with diabetes, healthy eating, exercise, and events with in the community. Recommended resources and educational materials targeted the fifth grade reading level since 50 percent of the health care population has difficulty reading beyond this grade level (Kocurek, 2009). Hands on instruction accompanied all equipment required for disease management with return demonstration. Tools, such as pillboxes, alarms, telephone reminders, text messages, and emails were implemented. Measuring program effectiveness occurs after three months via the ability to score Hb A1C less than or 80 equal to 7%. Frequency of lab draws thereafter correlates directly with the patient's ability to achieve and maintain this score. Challenges Failure to comply requires re-evaluation of teaching methods and patient reinforcement. Throughout patient contact, medical and ancillary staff must empower the patient and encourage self-management. Actions/Interventions Successful change ensues the development of a structured, thought out plan and the ability to influence others in pursuit of a common goal. Colleagues need validation for their ideas and concerns and should have an instrumental role in the process of change as we move toward patient-centered care (Grossman & Valiga, 2009). Lippitt’s change theory provided the conceptual framework behind transforming the organization’s approach to managing T2DM, the first step in modifying the management of all chronic illness treated at the clinic. Lippitt’s theory imitates the nursing process, assess, diagnose, plan, implement, and evaluate; the core of nursing practice (Lehman, 2008). Lippitt's assessment stage, Phase 1, established T2DM noncompliance as the problem requiring immediate attention. As the scope of T2DM noncompliance affects the organization as a whole, it is vital to present the plan of action to all relevant stakeholders. This includes Phase 2 motivating nurses, medical practitioners, medical director, and members of the board; all of whom are all ultimately responsible for the overall quality and patient safety. Including colleagues and peers in understanding the vision is an essential component of successfully implementing change (Grossman & Valiga, 2009). Phase 3 assessed the acceptance of the change-commencing Phase 4, establishing the plan. Phase 5 81 ascertained the group members’ function, role in the change process, the plan is in action and maintaining, and monitoring the success begins Phase 6. Phase 7 instituted permanence. Lehman (2008) found the following: The Nursing Professional Development Educator role includes that of change agent. Much of the literature addresses reaction to change rather than purposeful guidance of the process. This article describes the development of a planned change template. Distille