This paper considers my specialty focus and how it relates to my topic of choice for a nursing quality improvement program. The identified phenomenon of interest is the growing number of individuals with type 2 diabetes and the barriers that are present that prevent effective self-care. Predicted levels of diabetes amongst the population are set to reach 366 million by 2030, which will place significant burden on the patients, their healthcare practitioners and on healthcare expenditure. For these reasons, the concept of self-care is being investigated. The populations of interest are those who have type 2 diabetes and are residing in Jersey City, New Jersey, who are registered with a primary care practice. The knowledge of a cross section of both Hispanic and White patients will be assessed using the Starr County Diabetes Education questionnaire in order to assess their ability to self-care. The nursing model used is that of Orem’s self-care theory, which considers the ability of the patient to self-care, the self-care deficit and the required level of care from nursing interventions.

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Specialty Focus
I am an Advanced Practice Nurse and my specialty focus is Adult-Gerontology as a Primary Care Nurse Practitioner. In my practical experience and clinical nursing practice, I have identified that there are a number of barriers present in adult patients with diabetes that affect their ability for self-care. These include service accessibility (Nam, Chesla, Stotts, Kroon, & Janson, 2011), communication (Lyles & Schillinger, 2013), education (Lemes dos Santos, dos Santos, Ferrari, Fonseca, & Ferrari, 2014), lack of awareness (Kaiser, Vollenweider, Waeber, & Marques-Vidal, 2012), poor diet and lack of exercise (Oftedal, Bru, & Karlsen, 2011). The aim of this paper is to use my clinical expertise to evaluate some of these factors, which contribute to effective diabetes self-management among adult Type 2 Diabetes Mellitus patients between the ages of 18 and 64.

Phenomenon of Interest
It is currently estimated that globally, there are over 150 million people affected by type 2 diabetes with this figure predicted to rise to 366 million by 2030 (World Health Organization, 2016); however, the spread of diabetes is not uniform amongst the general population with Hispanic and other minority ethnic groups having higher prevalence rates than their White counterparts (Garcia, Villagomez, Brown, Kouzekanani, & Hanis, 2001).  Sedentary lifestyles, increased levels of obesity and the ageing population have all been blamed for the dramatic increases in diabetes prevalence over the past 20 years (Henson, Dunstan, Davies, & Yates, 2016; Paneni, Beckman, Creager, & Cosentino, 2013). For these reasons, there is an intense research focus on diabetes, with many studies aiming to determine the ways in which patient self-management can reduce the burden of the disease on the patient, on the practitioner and on health care expenditure. As such, the purpose of this quality improvement project is to evaluate the correlation between knowledge and education level, age and family income of Type 2 Diabetes patients using the Starr County Diabetes Education questionnaire in Spanish and English in order to assess the how knowledge affects self-care. The project also proposes to explore the interaction between socio-demographic variables and diabetes knowledge.

Population of Interest
The quality improvement project proposes to evaluate the knowledge of diabetes of adult patients aged between 18-64 years who are diagnosed with Type 2 diabetes. The study will be conducted in Jersey City, New Jersey with participants who are part of a primary care practice.  In primary care, prevention of Type 2 Diabetes, education and information are key factors for a successful treatment plan and necessary to promote overall wellness for the patients. Jersey City has a large Hispanic population, with the last census estimating that over 27% of the population are Hispanic or Latino (United States Census Bureau, 2015). As such, this project will allow for a comparison of knowledge levels between the different demographic groups within the city and assess whether the nursing interventions currently utilized are effective for all population groups.

Nursing Model
For the purpose of this project, Orem’s theory of self-care is considered the most fitting nursing model (Riegel, Jaarsma, & Strömberg, 2012). Orem’s self-care theory is made up of three other theories; the theory of self-care, the theory of self-care deficit and the theory of nursing systems. Orem’s theory defines nursing as an act of helping others in the management and provision of self-care with self-care being defined as the activities a patient performs on their own behalf in order to maintain their health, well-being and life (Gil Wayne, 2014). As such, the theory suggests that every individual is responsible for their own health and has the ability to perform self-care. However, self-care deficit occurs when the patients are unable to provide care for themselves resulting in a self-care demand (Masters, 2012). Orem’s theory of self-care therefore describes a situation where the nurse fulfils this demand for self-care by assisting the patient to maintain the required level of self-care with the level of nursing required being dependent on the degree to which the patients are able to meet their own self-care needs (Sitzman & Eichelberger, 2011).

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