In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice. BENCHMARK CAPSTONE: DIABETES IN HOME HEALTH 1

Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

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  1. Background
  2. Problem statement
  3. Purpose of the change proposal
  4. PICOT
  5. Literature search strategy employed
  6. Evaluation of the literature
  7. Applicable change or nursing theory utilized
  8. Proposed implementation plan with outcome measures
  9. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
  10. Appendix section, if tables, graphs, surveys, educational materials, etc. are created

Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center. BENCHMARK CAPSTONE: DIABETES IN HOME HEALTH 1

Diabetes in Home Health


Diabetes has become one of the major health issues across the globe and most importantly in America. Presently, the number of pre-diabetic and diabetic adult patients in America has passed the 100 million mark. In 2015, a total of 30.3 million individuals in America (9.4%) of the country’s population had diabetes (CDC, 2017). The diabetes statistics in United States are very alarming meaning that urgency is needed in addressing this issue. To reduce the high pressure in healthcare organizations, home healthcare has become very essential for diabetic patients. Diabetic patients, usually older adults are discharged from rehabilitation centers or hospitals earlier after being diagnosed with diabetes (American Diabetes Association, 2019). Therefore, these patients are taught how to manage diabetes while at home care facilities, particularly through various interventions. Home healthcare produces the desired health outcomes especially if there is an effective coordination between home care nurses and the patient. This discussion, therefore, focuses on diabetes and how a well-managed home healthcare can lead to the desired health outcomes.

Problem Statement

Owing to the huge number of individuals diagnosed with diabetes or prediabetes, patient pressure has mounted in healthcare facilities. This implies that home healthcare has become the next best alternative for diabetic patients. Diabetes is a chronic disease that impairs the ability of the body to process blood sugar. If not properly managed, diabetes results in buildup of blood sugars, thereby increasing the risk pertaining to serious conditions, for example, heart disease and stroke (American Diabetes Association, 2015). It is surprising that diabetes is not necessarily associated with old age. As a matter of fact, more than 250,000 individuals below 20 years in America are diagnosed with diabetes (Hoffman, 2014). Management of diabetes requires a high level of consistency and this can only be better achieved in home healthcare. Therefore, discovering workable solutions that aim at improving patients’ health outcomes is a priority especially considering that diabetes is a major cause of death in U.S., being ranked at number seven out of the major causes of deaths. This proposal is based on the following question; how effective is home healthcare compared to hospital-based in improving health outcomes of diabetic patients?

Purpose of Change Proposal

The principal purpose regarding change proposal is the identification and implementation of healthcare plan that could help in the improvement of diabetes management in home healthcare. The purpose of home care for patients with diabetes is to improve their health outcomes by consistently adopting various interventions such as medications, doing routine physical exercises, eating the proper diet etc. as recommended by the health professionals. Again, the change proposal aims at providing solutions on how home healthcare can be successful both to the hospitals that could have otherwise admitted the patients and the patients themselves through collaboration with home care nurses. Since diabetes is a pressing concern in America and hospitals have been overburdened by large number of diabetic patients, improving home healthcare is a priority (CDC, 2017). For this reason, the change proposal aims at giving an insight on some of the improvements that could be actualized in order to improve the quality of health outcomes for diabetic patients.


The cost of healthcare has significantly increased in America especially considering that millions of Americans who are diagnosed with diabetes require medical care. Therefore, it is imperative to implement various intervention measures for prevention or management of diabetes. In essence, provision of home healthcare is the best intervention owing to the fact that diabetes is a chronic disease. Home healthcare incorporates services and activities such as routine physical exercises, self-administering of insulin, self-examination of blood sugar level, observation of dietary habits as well as observation of other lifestyle behaviors that could increase the risk of diabetes. This intervention does not only help to manage diabetes but also reduces the risk of other lifestyle diseases as well as prolonging the patient’s life (Hoffman, 2014).


Healthcare for diabetic patients is either provided at home or in hospitals. Home healthcare has proved to be very effective as far as improving health outcomes for diabetic patients is concerned. To assess this effectiveness, certain questions could be used. How comfortable is the provision of healthcare services at home compared to hospitals? Does management of diabetes at home with assistance of home care nurses differ from such management in a hospital setting? How does home healthcare improve patient outcomes? Actually, home-based care is the best option since it reduces healthcare costs, offers specialized services and it is convenient and comfortable (American Diabetes Association, 2019).


It is evident that home healthcare has resulted to the improvement of health outcomes of diabetic patients. These patients require some autonomy and comfort that can only be best provided under home healthcare, something that is very crucial in improving the patients’ quality of life. With respect to management of symptoms, homecare health is very effective since it provides a supportive environment for the various recommended activities that specifically address diabetes symptoms (Hoffman, 2014).


The timeframe of the intervention is dependent on the specific health requirements of the patient. For example, for a diabetic patient who is overweight, it would require them to undertake routine physical exercises probably early in the morning and the evening. Also, checking for blood sugar levels could be done on a weekly basis while administration of insulin is done during the time recommended by the physician. Lastly, the visits by the home care nurse should be organized depending on the convenience of both the patient and the nurse or depending on emergencies.

Literature Search Strategy

The strategy employed for searching literature with regard to management of diabetes in home healthcare incorporates the use of credible and quality sources of information that specifically relates to the issue at hand. Therefore, the literature used has been gathered from peer-reviewed journal articles, credible websites of health-related organizations, books, newspapers, magazines and diabetes-related reports. Also, the bibliography sections of articles and reports were also utilized in gathering more credible information. To obtain the finest details with regard to the topic under discussion, the researcher also incorporated the use of key words and terms that pertain to diabetes and home healthcare. In order to obtain recent information, the search was limited to the last five years.

Literature Evaluation

First of all, the information used in this discussion is very relevant to the topic at hand because it is gathered from credible and quality sources. Secondly, the most current literature has been obtained by using sources published over the last five years. Thirdly, the sources utilized provide specific information that is very specific with regard to addressing both the problem statement and the research question. Again, the available literature on this topic is factual since it is based on scientific research which based on evidence and real case studies regarding diabetes and home healthcare.

Nursing Theory Applied

Self-management theory explains how self-efficacy can be enhanced in improving patient health outcomes especially for patients suffering from chronic conditions like diabetes. Essentially, healthy behaviors like successful symptom self-management have the potential of reducing suffering from diabetes (CDC, 2017). Here, home care nurses are very crucial as they play a significant role in the development of a plan regarding symptom self-management that is critical in the optimization of the patients’ behaviors regarding self-management of symptoms.

Proposed Implementation Plan and Outcome Measures

Implementation plan incorporates provision of diabetes-related education to the patient and/or their family with regard to prevention and management of diabetes; administration of insulin, blood sugar tests etc. It would also incorporate the provision of specialized services to the patient by home care nurse in the home setting as well as providing the patient with necessary equipment and resources to perform specific tasks (American Diabetes Association, 2019). Outcome measures would be related management of symptoms including; reduction of weight, reduction in fatigue, normal urination, improvement in vision etc.

Implementation Barriers and Ways of overcoming them

One of the barriers to implementation of the above plan is non-compliance by the patient to the list of recommended activities. This can be overcome by letting the patient understand the repercussions of non-compliance. Another barrier is lack of support by the family members. Here, the family members can be educated on how to provide a comfortable environment for the patient. Moreover, scarcity or inadequacy of home care nurses may also hinder the implementation process. The patient can seek the services of private nurses depending on their financial well-being. In addition, diabetes is chronic condition that requires huge costs for its management; therefore, the implementation could also be halted by high healthcare costs. These costs can be avoided through seeking government-sponsored healthcare programs like Medicaid or Medicare (CDC, 2017)

References American Diabetes Association. (2015). Home Helathcare and Diabetes Assessment, Care, and Education.

Running Head: PICOT 1


Comment by Crystal Bowman: Hi Yeni…..You did a good job overall with your paper. I do not see an actual PICOT question presented so it is difficult to tell what your primary focus is. Please see the comments for feedback. Thanks, Prof Bowman & Tania


GCU NRS-490Yeni Hernandez

Yeni HernandezGrand Canyon University: NRS 490 Comment by tania: Incorrect title page format. TitleStudent’s NameGrand Canyon University: course prefix and numberDate

December 9, 2018


This paper discusses the unprecedented complexities and issues related to dementia and particularly people living with dementia (PWD) and research in the field utilizing the quantitative measures to understand the severity of the symptoms as stipulated by Pan et al. (2013) of 51 patients with vascular dementia. The primary focus of the study is based on the demographics of old or aging populations who have been outlined as people at higher risks and prevalence of vascular and dementia complexities.

Problem/Patient Population

The research analysis presents the aging population as the primary population considering that dementia affects people in their senior years. The severities of the behavioral and psychological symptoms consistent with vascular dementia are outlined based on the metrics set through quantitative measures for 51 patients in three environments, diurnal, evening and nocturnal events. Considering that dementia dimension is mainly characterized by amnesia and memory loss the conflict in concern with this population, especially with the old or aging population, is presented through the effective delivery of care to and achieveing better patient outcomes for the PWD. patients. It is critical to note that dementia reduces the functionalities of the patients, thereby increasing the risks of other issues includingsuch as becoming unfit due to lack of exercise. among other concerns.


For this particular group of patients, the intervention is solely based on improving outcomes and maintaining a comfortable lifestyle for the outlined patients at risks (Hughes & Common, 2015). The intervention is based on a combination of two aspects:; exercise and medication. By iIntegrating a routine exercises plan to for patients with dementia, it has been shown that exercise can to improve memory loss symptoms as well as keep improving the patient fitness. It has been shown that rRegular exercise results in an improvements of brain functions in two ways; both indirect methods and direct methods. Indirectly exercise helps by stimulatinge and improvinge mood, and sleep, as well as reducinge stress and anxiety. Theseis is are common characteristics of vascular dementia in among the older populationgenerations. Directly the benefits are derived from the ability of exercise to reduce insulin resistance, decrease reducing inflammation and stimulateion of the growth factors. In the older population people with dementia, “chemicals or growth factors in the brain affect the health of brain cells, induce growth of new blood vessels in the brain as well as indices the abundance and survival rates of the new brain cells”. Comment by Budyn, Tania DMs Matrix Providers: Citation needed


It is notable that the majority of the patients are immobile due to degenerative old age issues and conditions. This means that they cannot engage in productive or useful exercises to stimulate their brains and growth factors. It is therefore imperative that a supportive environment, through informal caregiving, isbe instituted to facilitate their safety and relaxation of patients with dementia. A Ssupportive environment will allows the patient to access all the care services through the help of their informal caregiver or family member. This provides a comparison point to effectively measure how much the success of the intervention for the patients that are can engage in productive and useful exercise (Neubert et al., 2018).


The results or outcomes of an integrated exercise program for dementia patients prompted health care facilities to consider their choices with regards to the patient’s abilities and informal care availability in improving the outcomes of dementia patients. In other words, the teams must make decisions-based on what is best for the entire health status of individual patients. The outcome of the study is etched on improving the overall safety of a patient living with dementia by reducing and improving the symptoms to prevent cases of re-hospitalization resulting from injuries such as fall incidences.


The data from collection for the study that was done in 2013 was collected by nurses who primarily utilize questionnaires. The data collection also utilized diverse scales and tools of assessment to establish dominant symptoms such as the Neuropsychiatric Inventory (NPI), symptoms assessments the BEHAVE-AD scale among others (Pan et al., 2013). Comment by Crystal Bowman: For the purposes of this paper, the timeframe would be related to what timeframe you would be conducting your intervention in.


Hughes, J., & Common, J. (2015). Ethical issues in caring for patients with dementia. Nursing Standard, 29(49), 42-47. doi: 10.7748/ns.29.49.42.e9206

Neubert, L., König, H., & Brettschneider, C. (2018). Seeking the balance between caregiving in dementia, family, and employment: study protocol for a mixed method study in Northern Germany. BMJ Open8(2), e019444. doi: 10.1136/bmjopen-2017-019444

Pan, W., Yoshida, S., Liu, Q., Wu, C., Wang, J., Zhu, J., & Cai, D. (2013). Quantitative evaluation of the severity of behavioral and psychological symptoms of dementia in patients with vascular dementia. Translational Neurodegeneration, 2(1), 9. doi: 10.1186/2047-9158-2-9