Clinical Excellence Revisited

  1. How does your work done with Steps 1-3 of the Change Model link back to clinical
    excellence?
  2. What key outcome factors or variables will you focus on as you design your practice
    change?
  3. How might you evaluate the impact of your practice change to ensure you are
    working toward quality and clinical excellence?

Clinical Excellence Revisited

  1. How does your work done with Steps 1–3 of the Change Model link back to clinical
    excellence?
    By assessing the need for practice, I have learnt identified the erroneous believes of the
    healthcare providers on patient behavioural change to effectively manage Diabetes Type 2.
    This hinders clinical excellence in that it fails to address patient care holistically. This
    change model step is important because it facilitates in the identification of clinical
    experiences that fail to promote clinical excellence (Inzucchi, et al., 2015).
    The second step of analysis of diabetes enables me to understand that diabetes is a chronic
    disease that needs effective coping interventions. The synthesis of the evidence based
    practice identifies patient education as the great platform for ensuring lifestyle modification.
    Additionally, patient education is important as it addresses all components of healthy living

Clinical Excellence Revisited

2
as it addresses patient specific needs such as nutritional requirements, benefits of medication
adherence as well as the pharmacodynamics that could be attributable to drug interaction,
especially among paediatric and geriatric patients. These are essential components that
promote clinical excellence (Steinsbekk, et al., 2012).
Additionally, this change link model enables one to identify the potential barriers that are
associated with the proposed changes. Through this model, I have identified that
communication barrier is one of the main issue, which could result to staff resistance.
Additionally, this type of change requires commitment in terms of skills and resources, which
are the main challenge in this proposed study (Kayshap et al., 2013).

  1. What key outcome factors or variables will you focus on as you design your practice
    change?
    Designing this practice is not an easy task because it is subject to confounding values such as
    change in patient medication regimen which could influence the biochemical outcome.
    Additionally, it can be challenging having non-educated control group. In this context, the
    study design will focus on comparing special (evidenced based practice) education with the
    basic care education among the patient diagnosed with Type 2 Diabetes. Evidence based
    practice indicates that there are few long term effects on patient with self-management
    education program. One of such programs is the X-PERT (expert patient education) self-
    management education program, which is associated with empowering patients with the
    necessary skills, helping the patients to benefit in terms of the biomedical and psychosocial
    outcomes (Inzucchi, et al., 2012).
    The outcome variables that will be evaluated in this context includes the biomedical
    outcomes (includes Blood pressure, cholesterol level, HDL, LDL, glycated haemoglobin,
    weight as well as the waist circumference); the illness perception questionnaire, lifestyle
    questions, smoking status, emotional distress which is specific to diabetes will be evaluated.

Clinical Excellence Revisited

3
This will help determine the overall effect of the patient perceptions, their understanding
about diabetes, and their perception on their ability to manage diabetes (personal control)
(Steinsbekk, et al., 2012).

  1. How might you evaluate the impact of your practice change to ensure you are
    working toward quality and clinical excellence?
    It is vital to analyse the impact the proposed practice facilitates towards sustaining quality
    clinical excellence. This is because most of the practice conducted patient educations have
    not been conclusive; as each of self-management strategies have its own advantages as well
    as disadvantages. In this context, the evaluation will be made by comparing the results with
    other studies. This will facilitate in the identification of the active components that contribute
    towards clinical excellence. Additionally, it will help evaluate the outcome of goal setting
    when conducting education on self-management in people diagnosed with diabetes (Kayshap
    et al., 2013).

Clinical Excellence Revisited

4

References
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … &
Matthews, D. R. (2012). Management of hyperglycemia in type 2 diabetes: a patient-
centered approach position statement of the American Diabetes Association (ADA)
and the European Association for the Study of Diabetes (EASD). Diabetes
care, 35(6), 1364-1379.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … &
Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a
patient-centered approach: update to a position statement of the American Diabetes
Association and the European Association for the Study of Diabetes. Diabetes
Care, 38(1), 140-149.
Kashyap, S. R., Bhatt, D. L., Wolski, K., Watanabe, R. M., Abdul-Ghani, M., Abood, B., …
& Kirwan, J. P. (2013). Metabolic Effects of Bariatric Surgery in Patients With
Moderate Obesity and Type 2 Diabetes Analysis of a randomized control trial
comparing surgery with intensive medical treatment.Diabetes care, 36(8), 2175-2182.
Steinsbekk, A., Rygg, L., Lisulo, M., Rise, M. B., & Fretheim, A. (2012). Group based
diabetes self-management education compared to routine treatment for people with
type 2 diabetes mellitus. A systematic review with meta-analysis. BMC health
services research, 12(1), 213.

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