Purdue University Home Health Nurses’ DFU Educational Program Paper Utilize all of the course materials (written Assignments, Discussions, peer review feed

Purdue University Home Health Nurses’ DFU Educational Program Paper Utilize all of the course materials (written Assignments, Discussions, peer review feedback, journal articles, textbook and website readings), to summarize your project in an 8-10 page (excluding title page and references) formal paper. The Assignment should include verbiage regarding how interprofessional education is utilized, and the application of cultural competence applied, in designing, developing and implementing the project. This paper should be written from the perspective of a nurse educator leading EBP change. My target audience for my EBP is Home Health nurses who provide wound care for patients with diabetic foot ulcers.My project is the creation of a wound care path with educational material that will guide the nurses to proper wound care and proper education to patients in order to prevent amputation. 1
Running Head: GAP Analysis
Stacey Lambert
Purdue University Global
MN 590 Unit 6 Assignment
Dr. Tina Vaughn
September 18, 2019
2
Running Head: GAP Analysis
Current State
Peer review has not been
utilized as a mechanism of
self -regulation for RNs to
ensure delivery of quality
care and promote
accountability.
(Semper et al. 2016).
Diabetic foot ulcers (DFU)
are increasingly prevalent,
and associated with
significant morbidity,
mortality, and cost.
(Somayaji et al. 2017).
Desired State
Identified Gap-Difference
Between Current State and
Desired State
Nurses who incorporate
Nurses should be trained
peer review in their
regularly by a clinical
professional nursing
nurse specialist to enhance
practice models will lead to their professional skills and
promotion of
mentor their practice for
accountability in nursing
higher quality services.
practice.
(Semper et al. 2016).
Creating an educational
program led by a clinical
nurse specialist will help to
transform the delivery of
quality care by the nurses
to a professional level.
(Semper et al. 2016).
Implementation of an
Communication among
intra-professional team
clinicians and lack of an
approach in patients who
interdisciplinary approach
are already on medication
to manage DFU have been
for treatment of DFU can
identified as barriers to
have several positive
successful of care for
impacts on diagnosing and diagnosis and treatment of
managing diabetic foot
DFU.
ulcers (DFU) and
prevention of limb loss.
Lack of usage of a clinical
(Somayaji et al. 2017).
pathway provides little
direction for the team and
is interfering with an
individualized plan of care
for treatment of DFU and
prevention of limb loss.
(Somayaji et al. 2017).
Barriers to Best Practice
Implementation
Training is not being
offered on a regular basis
to the nurses, which is
leading to poor quality
care.
(Semper et al. 2016).
Unsuitable approaches
used to diagnose and
manage DFU for a patient
on medication.
Several negative impacts
arise from the applied
approach thereby affecting
the success of the
medication process for
these patients.
(Somayaji et al. 2017).
Methods used to Identify
and Implement Best
Practices
Completion of a need’s
assessment helped to
identify knowledge
deficits. Clinical nurse
specialists played a critical
role in helping staff nurses
understand peer review and
its application to practice
and improved
accountability in their
nursing practice.
(Semper et al. 2016).
Means and the standard
deviation was used to
describe the continuous
variables. Median and
interquartile ranges were
used in describing the
distributed variables in the
data.
Pathways for DFU
management are
recommended to facilitate
diagnosing and
management of DFU
patients under medication
management.
(Somayaji et al. 2017).
3
Running Head: GAP Analysis
Diabetic foot ulcers cause
economic burden to the
nation. Over 16, 000
hospital admissions for
diabetes foot ulcers (DFU)
have been reported and
over 31, 000 DFU patients
reported to visits to the
clinic. Several surgical
debridement’s and
amputations were also
noted (Hopkins et al.
2015).
There is need to minimize
the economic burden
caused by the DFU,
through reducing the
prevalence of DFU illness
at a national level. The
health sector will subject
DFU patients to suitable
medication to reduce the
burden brought about by
the illness (Hopkins et al.
2015).
The current approximated
figures are higher than the
desired values. The budget
allocation is too high and
has resulted into economic
burden, thereby affecting
the control of DFU cases
nationally. Over 16, 000
patients admitted for DFU
illness, and over 31, 000
visit the clinic to seek
medical services (Hopkins
et al. 2015).
A significant inverse
correlation exists between
diabetes related to lower
limb amputation and
provision of foot care
services.
Efficient foot care services
will be achieved thus
reducing the cases of lower
limb amputation. (Paisley
et al. 2018).
A direct correlation exists
between diabetes linked
amputation and the
delivery of adequate foot
care services (Paisley et al.
2018).
Effective foot care services
have a significant reduction
in amputation.
(Paisley et al. 2018).
Little knowledge exists
There will be sufficient
concerning the outcomes of knowledge on negative
negative pressure wound
pressure wound therapy
There is a gap in receiving
consistent pressure for the
It is difficult to rely on
estimated values to obtain
the economic burden since
the values can exceed the
expected figures budgeted
for. Estimation of national
resource utilization may
fail to identify the misused
resources and may result in
excessive allocation and
utilization of the allocated
resources (Hopkins et al.
2015).
Standardized and
mandatory health databases
were used. Four national
databases were used for
data collection and
analysis. ICD-10 CA codes
were used to identify the
cases.
All DFU patients will be
enrolled for medication to
manage the prevalence of
the disease.
The utilization of the
allocated resources will be
done to ensure efficient use
of public resources to
reduce the national
economic burden (Hopkins
et al. 2015).
The study focused on
Data came from patients’
South Devon region of the screening, audit reports and
UK and it may result into
other verified sources and
misleading interpretation if presented to Yorkshires
the data were inaccurate.
public health observatory
Data from several regions
hospital as episode
should have been used to
statistics. The outcome is
represent a larger
that there will be effective
population and more
provision of foot care
accuracy in identification
services as this has a
of trends so as to determine significant reduction in
the actual correlation
amputations associated
(Paisley et al. 2018).
with diabetes (Paisley et al.
2018).
There was no standard
The study relied on
sample size that was used
previous studies, and no
in the study. The study was
4
Running Head: GAP Analysis
therapy (NPWT) that is
utilized in the treatment of
diabetic foot ulcers (Wynn,
2019).
(NPWT). The existence of
enough NPWT will allow
treatment of diabetic foot
ulcers thereby minimizing
the prevalence of the
illness (Wynn, 2019).
devices used for NPWT
(Wynn, 2019).
flawed since it did not
include any validated tool
for the research process
and no statistical tools
were used in calculating
the sample size (Wynn,
2019).
Approximately 15 percent
of the world’s population is
impacted with diabetes
mellitus and are at risk of
developing a diabetic foot
ulcer infection (DFU). The
National Institute of
Health’s report shows that
DFU affects over 10
percent of patients with
diabetes mellitus
(Yazdanpanah, Nasiri &
Adarvishi).
A multidiscipline approach
will be applied to minimize
the occurrence of the DFU
amongst the world
population (Yazdanpanah,
Nasiri & Adarvishi).
The current figures of DFU
infection globally are very
high and require immediate
intervention
Secondary data from
Global Public Health is
used instead of searching
for primary data.
(Yazdanpanah, Nasiri &
Adarvishi).
Presently, as many as 1 in
4 patients with diabetes
develops a DFU, of which
at least one-quarter do not
heal, putting patients at risk
Minimize the occurrence of
diabetes globally in order
to reduce the prevalence
and burden of DFU.
There are minimal
guidelines for clinicians
that focus on interventions
that decrease the burden
and costs of all stages of
diabetic foot syndrome.
The projected figures for
prevalence of DFU by
2030 indicate increased
prevalence with over 350
million at risk.
(Yazdanpanah, Nasiri &
Adarvishi).
Inadequate foot care
education is provided to
patients Foot specialists
offer the diabetic patients
quarterly primary care,
footwear, and education on
standard sample size data
used.
Valid statistical tools need
to be used to obtain results
since previous studies may
have misleading or
inaccurate information.
All the included studies
reported that NPWT led to
better clinical outcomes
when compared to standard
treatment.
(Wynn, 2019).
Early effective
management of DFU using
a multidisciplinary team
can reduce the severity of
complications and improve
overall quality of life.
Nurses should advocate for
application of a
multidiscipline approach to
mitigate the occurrence of
diabetes foot ulcers among
the world population and
educate the world
population on prevention
of diabetes.
(Yazdanpanah, Nasiri &
Adarvishi).
Several prospective and
observational studies
carried out to determine the
trends of DFU globally.
5
Running Head: GAP Analysis
of amputation. (Hart,
Milner & Cifu).
Nurses can carry out
regular follow ups to
patients to monitor the
healing process of the
wound (Hart, Milner &
Cifu).
Minimal education is
provided for preventive
measures for DFU.
how to manage DFU, but
nurses can play a larger
part in the education of
patients. (Hart, Milner &
Cifu).
A comprehensive
multidisciplinary approach
can be used for the
provision of foot care
services. Regular follow up
is needed to monitor the
healing process of the
wound. Nurses can be
instrumental in the early
identification and treatment
of complications to prevent
amputation.
(Hart, Milner & Cifu)
6
Running Head: GAP Analysis
References
Hart, T., Milner, R., & Cifu, A. (2017). Management of a diabetic foot. Jama, 318(14), 1387-1388
Hopkins, R. B., Burke, N., Harlock, J., Jegathisawaran, J., & Goeree, R. (2015). Economic burden of illness associated with diabetic foot ulcers in
Canada. BMC health services research, 15(1), 13.
Paisley, R. B., Abbott, A., Levenson, R., Harrington, A., Browne, D., Moore, J., … & South?West Cardiovascular Strategic Clinical Network peer
diabetic foot service, review team. (2018). Diabetes?related significant lower limb amputation incidence is strongly related to diabetic foot
service provision and improves with an enhancement of services: peer review of the South?West of England. Diabetic Medicine, 35(1), 53-62.
Semper, J., Halvorson, B., Hersh, M., Torres, C., & Lillington, L. (2016). Clinical nurse specialists guide staff nurses to promote practice
accountability through peer review. Clinical Nurse Specialist, 30(1), 19-27.
Somayaji, R., Elliott, J. A., Persaud, R., Lim, M., Goodman, L., & Sibbald, R. G. (2017). The impact of team based interprofessional comprehensive
assessments on the diagnosis and management of diabetic foot ulcers: a retrospective cohort study. PloS one, 12(9), e0185251
Wynn, M. (2019). The efficacy of negative pressure wound therapy for diabetic foot ulcers: A systematized review. Journal of tissue viability
Yazdanpanah, L., Nasiri, M., & Adarvishi, S. (2015). Literature review on the management of diabetic foot ulcer. World journal of diabetes, 6(1), 37.
Literature Review
1
Stacey Lambert
Purdue University Global
MN 590 Unit 2 Assignment
Dr. Tina Vaughn
August 13, 2019
Literature Review
Sample: Size
of Sample,
Hypothesis,
Important
APA Citation
Question, or
Study Design Demographics,
Purpose.
Inclusion and
Exclusion
Criteria
Semper, J.,
The primary
To make sure
The
Halvorson, B.,
purpose of
that there is
demography of
Hersh, M.,
this article is
the delivery of the study is
Torres, C., &
describing its quality care
specific to the
Lillington, L.
role of clinical and
community. A
(2016). Clinical
nurses in the professionalism peer review is
nurse specialists creation and
in self vital for the
guide staff
of the
regulation,
development of
nurses to
educational
peer review is
nursing as a
promote practice program
essential. Thus, profession and
accountability
targeting the peer review
the area that
through peer
nurses,
incorporation
the research
review. Clinical
practices
in the nursing
was focused on.
Nurse
about
practice is
Specialist, 30(1), accountability essential.
19-27.
by the use of
principles of
peer-review.
Somayaji, R.,
The study is
The
The study was
Elliott, J. A.,
aimed at
assessment
carried out on
Persaud, R., Lim, assessing the was done on a 308 patients
M., Goodman, L., impact that
group of
being screened.
& Sibbald, R. G.
the approach patients
The mean
(2017). The
of the intraattending a
average of
impact of team- professional
large regional
participants was
based
team has on
community
64.2 years.
2
Data Collection
Implications/Conclusions
Instruments/Procedure
Statistical
Related to Adoption to
Including Reliability Results/Findings
Practice
and Validity
An educational program
was developed by the
association of the
clinical nurse specialists.
Potential barriers, as
well as learning needs,
were identified using a
baseline needs
assessment. Tools and
strategies for building
communication skills.
The educational
program
increased in the
knowledge of the
nursing staff.it
also increased
the use of the
principles peerreview at work.
Specialist in the clinical
sector play a very crucial
role in helping medical
practitioners understand
the working of peer
reviews and how the
principles are put into
practice.
Data on the patients
was collected by a team
of an intra-professional
team in Toronto would
healing center
(TRWHC).
Means and the
standard
deviation was
used to describe
the continuous
variables.
Median and
interquartile
The intra-professional
team is associated with an
improved rate of
diagnostic as well as
would healing outcomes
in comparison to other
conventional care
services. Pathways for
Literature Review
3
interprofessional
comprehensive
assessments on
the diagnosis
and
management of
diabetic foot
ulcers: a
retrospective
cohort
study. PloS
one, 12(9),
e0185251.
the
diagnosing
and
managing of
DFU for a
group of
patients
already put
on
medication.
care access
center (CCAC)
Hopkins, R. B.,
Burke, N.,
Harlock, J.,
Jegathisawaran,
J., & Goeree, R.
(2015).
Economic
burden of illness
associated with
diabetic foot
ulcers in
Canada. BMC
health services
research, 15(1),
13.
The main aim
of the
research was
to identify
and estimate
the burden
and identify
the illness.
The
prevalence
and
incidences of
DFU at a
national level
was
determined.
DFU cases
were
estimated.
Cases for five
years were
analyzed using
the linked
databases for
health care
reports.
National
resource
utilization was
also estimated.
The
widespread
resource use
regarding DFU
cases was
determined.
However,
individuals
above 18 years
were included
who had a
history with
diabetes
mellitus.
ranges were
used in
describing the
distributed
variables in the
data. The results
showed a
significant
number of
infections, with
over 90 percent
had deep and
surrounding
infection.
Standardized
Four national databases Over 16, 000
and mandatory were used for the
hospital
health database analysis and data
admissions for
was used. Thus collection. ICD-10 CA
DFU cases were
the scale is
codes were used to
reported. Over
rolled out at a
identify the cases. The
31, 000 cases
national level,
resource use by the DFU were reported
however
cases was estimated in
for visits in the
specifically
dollars.
clinics, several
targeting the
surgical
DFU incidences
debridement’s
as reported in
and amputations
the database.
were also
recorded.
diabetic for intraprofessional foot care are
recommended. More so,
foot care is recommended
to be availed.
The conclusions are that
the annual DFU cases and
the associated burden, for
cases with at least one
admission or clinic visit is
high than the reported
cases in five years. This
also includes the annual
budget
Literature Review
Paisley, R. B.,
Abbott, A.,
Levenson, R.,
Harrington, A.,
Browne, D.,
Moore, J., … &
South?West
Cardiovascular
Strategic Clinical
Network peer
diabetic foot
service, review
team. (2018).
Diabetes?related
significant lower
limb amputation
incidence is
strongly related
to diabetic foot
service provision
and improves
with an
enhancement of
services: peer
review of the
South?West of
England. Diabetic
Medicine, 35(1),
53-62.
4
This study
was aimed at
investigating
the
relationship
between the
lower limb
amputation
and the
services for
foot care.
Peer-review of
South Devon
areas in the UK
was studied to
assess how the
foot care
services in this
region are
delivered.
The study was
designed for a
specific region.
South Devon
was chosen for
the study. Thus
patient data
from this region
of the UK was
used.
The data for the study
was provided by the
Yorkshires public health
observatory hospital
episode statistics. This
data came from
patients screening, from
audit and other
sanctioned and verified
sources.
Initial reviews
indicated that
major
amputation
incidences within
the three years
associated with
diabetes had a
direct correlation
with the delivery
of adequate foot
care services.
The study found out that
there was a significant
inverse correlation
between diabetes related
to the lower limb
amputation and with the
provision of foot care
services. Effective foot
care services had a
significant reduction in
amputation cases.
Literature Review
APA Citation
Wynn, M. (2019).
The efficacy of
negative pressure
wound therapy for
diabetic foot ulcers:
A systematized
review. Journal of
tissue viability.
Yazdanpanah, L.,
Nasiri, M., &
Adarvishi, S. (2015).
Literature review
on the
management of
diabetic foot
ulcer. World journal
5
Sample: Size
of Sample,
Data Collection
Hypothesis,
Important
Implications/Conclusions
Study
Instruments/Procedures
Statistical
Question, or
Demographics,
Related to Adoption to
Design
Including Reliability
Results/Finding
Purpose.
Inclusion and
Practice
and Validity
Exclusion
Criteria
The study relied
The main
For the
on previous
Compared to the standard
aim of the
qualitative
studies that had
clinical treatments, the
study is to
analysis, seven
The design of
been carried
studies that included the
bring into
studies were
the study is
out in previous
This study did not
NPWT were seen to have
light the
added in the
set on the
studies.
include a standard
better clinical outcomes.
current state
qualitative
British
Therefore,
conventional method or
However, the study was
of
analysis. A
nursing
there was not a
means to calculate,
flawed in such because it
knowledge
range of
index. In this
standard
validate, or collect the
did not include any
on the
methodologies
study, a
sample size that
data that was used for
validated tool in the
negative
that led to the
search was
was used in this
the study.
whole of the study. For
would
birth of 3 main
undertaken particular study. There was no consistent
instance, there was no
therapy
themes was
on the
Studies
pressure for the devices
standard measure for the
(NPWT) that
used. These
PubMed and
published
used for NPWT
wound area and depth.
used in
were what
CINAHI
between 2008
No statistical tools were
treating
formed the
and 2018
used in calculating the
diabetic foot
qualitative
underwent peer
sample size.
ulcers (DFU)
analysis.
review.
The purpose An approach
The data is about 285
The results
The study establishes
of the study
strategy is
million cases that have
show that
that unless a prompt and
is to
suggested for The data used
been recorded globally.
abput15
a multidiscipline approach
establish the
managing
in the study is
This is without putting
percent of the
is taken, foot ulcers in
current state
DFU. The
from the global
into perspective the
world
diabetic person are going
of DFU and study designs public health.
global projection of over population with to continue causing more
suggest the
a new
350 million individuals by
diabetes
agony like amputations.
measure
management
2030 will be at risk
mellitus being
Thus, the need to
Literature Review
of diabetes, 6(1),
37.
6
that can be
adopted to
mitigate and
manage the
risk of DFU.
strategy
where a
wound can
be easily
achieved by
using an
array of
measures.
For the study,
2376 patients
This
The study
are used. Over
guideline is
uses a
20 studies are
focused on
Semmescarried on the
the
Weinstein
patients. Special A single trial randomized
interventions test that has
attention is
145 patients who have
that can be support from
Hart, T., Milner, R.,
given to the
diabetes are used.
m…
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