Type 11 diabetes

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be above 15%.
Construct a 2,500 word minimum case report that includes a problem or situation
consistent with a DNP area of practice.

  1. Use a minimum of any two theories 1) Dorothea Orem�s Self-care Theory and Health
    Belief Model.
  2. Apply one or more theories to describe understanding of the problem or situation of
  3. Apply one or more theories to the recommended intervention or solution being proposed.
  4. Develop the case report across the entire scenario from the identified clinical or health
    care problem through proposing an intervention, implementation, and evaluation using an
    appropriate research instrument.
  5. Describe the evaluation of the selected research instrument in the case report.
  6. Lastly, explain in full the tenets, rationale for selection (empirical evidence), and clear
    application using the language of the theory within the case report.



The incidence of type 11 diabetes has been increasing at a remarkable rate across the
world. In addition, type 11 diabetes is a chronic and progressive disease that requires continuous
assessment, identifying risk factors, intervention and education to reduce related complication.
According to Stokes & Preston (2017), type 11 diabetes is one of the leading causes of deaths in
the US. At the moment, about 18.8 million persons have been diagnosed with type 11 diabetes
and the number is projected to increase to 366 million by 2030 (Brunisholz et al., 2014).
Identification and prevention are important components in terms of reducing the severity of type
11 diabetes. Nonetheless, there is no formal program for education patients about type 11
Evidence shows that about 50% of individuals diagnosed with type 11 diabetes have
access to diabetes self-management education (DSME) (Powers et al., 2017). As a chronic
condition, it is necessary to persons diagnosed with type 11 diabetes to have direct self-
management choices in a bid to enhance care education. The DSME presents a platform to help
persons with type 11 diabetes navigate such choices as well as activities while improving health
outcomes (Brunisholz et al., 2014). By and large the essay will use the Health Belief Model
(HBM) and Dorothea Orem’s self-care theory to create and validate DSME module. Presently,
there is lack of type 11 diabetes programs for senior residents in the community; nonetheless, the
little knowledge these senior residents have is acquired from one another or providers.
Implementing type 11 diabetes education within the community can help to prevent the progress
of and/or development of the condition.


Brief literature review

As the disease process and mortality change, non-communicable illnesses have replaced
communicable infections (Mohebi, Azadbakht, Feizi, Sharifirad & Kargar, 2013). Nonetheless,
while there is no specific treatment for managing diabetes, health providers ought to understand
the significance of non-pharmacological intervention in reducing the prevalence of diabetes.
Research shows that DSME is non-pharmacological intervention for reducing diabetes (Mohebi
et al., 2013). Though knowledge is important, creating awareness among diabetes patients in
terms of managing diabetes is equally paramount. At that point, DSME becomes a patient
empowering model because it allows them to take a leading role in managing the condition
(Mohebi et al., 2013).
DSME is a collaborative procedure where type 11 diabetes patients and those at risk of
diabetes get relevant skills and knowledge to change behaviors while self-managing the
condition (Brunisholz et al., 2014). Type 11 diabetes education programs involve daily tasks
including taking medication, insulin, healthy diet and participation in exercise. Adults are in
charge of their self-management. In past research, it was demonstrated that self-care theory can
help diabetes patients to control glucose, prevent complication and diabetes related costs.
According to Liddy, Blazkho & Mill (2014), HBM presents variables that can be utilized
to measure the effects of psychosocial constructs on an individual’s readiness to participate in
while maintaining healthy behaviors. Moreover, HBM is a reliable model in preventing
unhealthy actions. Literature has investigated the application and efficacy of HBM in diabetes
management, adherence to treatment plans and developing prevention programs (Liddy et al.,
2014). This suggests that the use of HBM can increase awareness of outcomes after adopting a
prevention initiative; predict healthy behaviors and good component to DSME program.


Description of the case/situation/conditions:
To guide this easy, HBM and Orem’s self-care theory would be applied.
Orem’s self-care deficit theory
Orem developed the self-care theory to help nurses provide nursing care. In this theory,
the patients have or lack the capacity to care for themselves. In evaluating and making
interventions, nurses put emphasis on patients’ ability to provide self-care (Shrivastava,
Shrivastava & Ramasamy, 2013). Self- deficit theory helps nurses to recognize patients’
behaviors. With regards to patients with type 11 diabetes, self-care deficit involves lack of
knowledge, poor dietary choices or inadequate funds to buy medication. Orem’s theory includes
self-care, self-care deficit and nursing system. For patients with type 11 diabetes, Orem’s theory
concentrates on the ability of patients to conduct their daily activities. Essentially, with the self-
care theory, a patient makes appointments with a healthcare provider to address type 11 diabetes
and create a care plan. Moreover, the care plan depicts American diabetes Association (ADA)
guidelines and contacted regularly to see the progress made. Specifically, the self-care theory
offers guidance for patients to self-manage type 11 diabetes.
Health belief model
Similarly, the health belief model (HBM) is appropriate in terms of managing chronic
diseases (McEwen & Wills, 2017). In addition, the HBM is essential in measuring the chance of
people to act in accordance with discernment of disease process. The health HBM is a
physiological theory widely used to envisage health behaviors (Cook, 2018). In addition, the
model evaluates beliefs as well as attitudes of people. It is hypothesized that individuals are
afraid of illnesses, for that reason, the model evaluates the probability of individual actions

towards the disease. Since providers are in a position to change patients’ views, then patients are
likely to adhere to health lifestyles and recommendations (McEwen & Wills, 2017). The
concepts of health belief model include; perceived susceptibility, perceived severity, perceived
benefits, perceived barriers, cues to action and self-efficacy (Romano & Scott, 2014).
Effective assessment of type 11 diabetes is crucial because it helps to make inquiries
about what the condition means to patients. Also, it is necessary to detect barriers and
determination. In this case, addressing the perceived susceptibility should focus on helping a
patient with type 11 diabetes understand the magnitude of risks. Perceived severity demonstrates
the patient’s views of how they the diseases developed. On the contrary, perceived severity is the
patients ‘perception about the seriousness of the disease and potential consequences (Romano &
Scott, 2014). Signs and symptoms can enhance a patient’s degree of threat and experiences.
Therefore, the perceived severity concentrates on recommending actions and impacts of poor
health behaviors and the progress of type 11 diabetes.
Consequently, perceived benefits reflect a patient’s point of view concerning how the
efficacy of the recommendations can reduce complications associated with type 11 diabetes
(Romano & Scott, 2014). In addition, perceived benefits entail reducing the risks of the diseases
or ensuring positive response to intervention. As a result, perceived benefits can only be realized
if providers describe the suitable actions to help a patients diagnosed with type 11 diabetes attain
positive outcomes. Barriers have a significant influence in patient’s actions. The perceived
barriers enable the patient to understand challenges that could hinder attaining positive
Some of the barriers are access and cost of health. Although barriers should be identified,
patient’s information belief about type 11 diabetes ought to be dismissed. Cues to action

demonstrate a patient’s willingness to change behaviors whist combining unhealthy decisions.
Cues to action can support behavior change. The benefits of the behavior should be positive and
considered beneficial. Ultimately, the patient should view importance of behavior change as
positive action.


Scholars have investigated diabetes and demonstrate the importance of a patient being
accountable and also remain proactive in the care process. For instance, research shows that self-
management entails changing health beliefs and self-care to assess, guide and measure patient’s
accountability (Brunisholz et al., 2014). Adherence to self-management highlights gradual
changes with respect to disease, independence and self-care activities. However, self-care tasks
could be distressing and requires changes in life that are overlooked leading to increased risk of
type 11 diabetes (Mohebi et al., 2013). In spite of previous studies, self-care can considerably
help patients with type diabetes control HBA1c and glucose. Implicitly, there is a positive
outcome of self-care on glucose and hemoglobin (Brunisholz et al., 2014).
Moreover, diabetics that comply with self-care can considerably reduce hemoglobin.
Nonetheless, self-care activities in patients with diabetes are not suitable (Liddy et al., 2014).
Involvement and taking the leading role are main elements of self-care in controlling the effects
of the disease. Inasmuch as self-care activities fail to result in effective control of metabolic,
ignorance leads to weakness in a patient’s metabolic state. In a study by Mohebi et al. (2013), for
instance, DMSE is viewed as the cornerstone of treating type 11 diabetes since it empowers a
patient to manage the disease. Nevertheless, some experts allege that increasing knowledge
among diabetic patients alone is not adequate in self-care actions since they are not sustainable
(Al-Mutairi et al., 2015).

Consequently current evidence shows that self-efficacy is an appropriate driver for self-
managing chronic conditions such as diabetes. Self-efficacy is a HBM concept that works as a
part of basic individual skills. Again, self-efficacy involves person’s judgment of their ability to
organize and adopt behavior to realize desired health outcomes. Self-efficacy is a component of
behavior because it is viewed as an autonomous aspect of basic individuals’ skills. Self-efficacy
is a vital part of HBM that comprises people beliefs. Human beings have self-management
systems that are used to control emotions, thoughts and action. And yet, using HBM as a
theoretical framework in self-management comes with an array of controversies. Evidence shows
that theory is an effective indicator of health behavior instead of HBM (Rezapour, Mostafavi &
Khalkhali, 2016). Nonetheless, the four concepts of HBM including perceived susceptibility,
severity, barrier, benefits and self-efficacy demonstrate that it is suitable in understanding
attitudes about prevention of diabetes.

Summary of the case

Diabetes is a chronic illness associated with different complications. In addition, diabetes
is linked to obesity, low socio-economic status, poor nutrition and history of diabetes (Powers et
al, 2017). The incidence of diabetes is high in rural areas than urban centers as a result
inadequate specialties; access challenges, cultural practices. According to CDC (2017), diabetes
is a serious problem among senior citizens in the US. As of 2015, there were 30.3 (9.4%)
million Americans with diabetes while 84.1 million had prediabetes, a disease that if not well
managed leads to type 11 diabetes (CDC, 2017). Even though new diagnoses are constant, it
continues to represent a serious health concern. For instance, in 2015, diabetes was a leading
cause of death in United States. As such, diabetes self-management education can help in
facilitating skills, ability and knowledge for self-care (Mohebi et al., 2013). Important elements

of self-management include self-care and behavior change.
The DSME can help patients to self-care and changing health behaviors. Additionally,
DSME has shown improved clinical outcomes as well as reduce complication related to diabetes
(Brunisholz et al., 2014). Self-management is crucial for patients with diabetes in terms of
monitoring disease process, prevent risk, control glycemic resulting in enhance quality of life. N
effective diabetes self-management focuses on various elements including cultural awareness,
group education and behavior goal setting. The objectives of DSME is to increase decision
making in care, improve self-efficacy, enhance quality of life, while reducing mortality and
morbidity (Mohebi et al., 2013). Successful DSME fosters continuous support to manage
diabetes. Rezapour et al. (2016) state that culturally based DSME enhances self-management in
racial and minority populations.

Proposed solution:

The proposed solution is implementing DSME program. This program is believed to be
an effective intervention for caring persons with diabetes (Beck, Greenwood, Blanton, Bollinger,
Butcher, Condon & Kolb, 2018). Furthermore, DSMES is a continuous process that facilitates
not only knowledge but also skills and ability for self-managing diabetes. DSME also
emphasizes on behavior change required for a patient to manage diabetes. This solution is
proposed because it will present health providers an opportunity to identify patient needs so as to
deliver patient-centered measures. Additionally, DSME is critical in managing diabetes while
delaying or preventing complications (Beck et al., 2018).
Essentially, the solution would define quality and help providers delivering diabetes
education to use DMSE evidence-based practice. Adoption of this solution would lead to
improved health outcomes, quality of life and reduce medical expenses as well as hospitalization

(Strawbridge et al., 2017). DSME can increase hemoglobin by roughly 0.6% without adverse
effects. Nevertheless, hemoglobin can significantly increase if the patients use DSME for more
than ten hours (Chrvala, Sherr & Lipman, 2016). Another inadequacy is that DSME is tailored
for various audiences with varied needs and outcomes, hence it is important to take into account
the National Diabetes Prevention Program (Beck et al., 2018). Moreover, the solution can only
be effective if Center for Disease and Prevention (CDC) curriculum is integrated in DSME to
achieve improved clinical outcomes so as to delay or prevent type 11 diabetes.

Research Instrument:

Diabetes Knowledge Test (DKT)
Since this paper proposes the use of DSME to manage type II diabetes, to evaluate the
efficacy of DSME in diabetes self-care, especially with respect to improved outcomes and
reduced complications, the study will use Diabetes Knowledge Test (DKT) instrument. The
Michigan Diabetes Research Training Center (MDRTC) invented the DKT tool for instructors
and scholars (McTernan & Matthews, 2015). As a two-fold tool with 23-itemized questions, it
measures diabetes knowhow. The first section of DKT comprises of general questions and it
applies to persons with type II diabetes and also type I. The second part of the toolkit uses
insulin. The broad spectrum section has questions associated to: (1) diet, (2) HbAlc, (3)
hypoglycemia control, (4) activity, (5) impact of the condition and infection on the levels of
blood sugar, (6) foot care (7) diabetic neuropathy symptoms (McTernan & Matthews, 2015).
The scoring aspect is accomplished by summing questions that are answered correctly. A
high score is implicit of the fact that an individual has a greater knowledge concerning diabetes
and management of diabetes than those with lower scores. The benefit that comes with DKT is
that it can be self-administered. The 6 th grade is the readability level. Again, it takes not only 15

minutes to administer the tool, but it is also easy to use the instrument on a number of
participants. The fidelity of the sample can be tested with Cronbach’s alpha. Moreover, content
rationality can also be tested with the evaluation of scores, by the type of diabetes, education
level and previous diabetes education (McTernan & Matthews, 2015). Essentially, the DKT
lessens the patient weight when it comes to the time needed to read report and self-manage.


As demonstrated in this essay, type II diabetes is a fatal condition that affects millions of
Americans, especially the elderly. Consequently, more than 84.1 million Americans have been
diagnosed with prediabetes, which requires substantive management lest it culminates into type
II diabetes. In this case, self-managing the condition through the DSME model offers the best
avenue. In addition, there is need for healthcare facilities and researchers to adopt the right tools
such as DKT to be able to quantify the efficacy of the DSME model among the elderly.



Al-Mutairi, R. L., Bawazir, A. A., Ahmed, A. E., & Jradi, H. (2015). Health beliefs related to
diabetes mellitus prevention among adolescents in Saudi Arabia. Sultan Qaboos
University Medical Journal, 15(3), e398.
Beck, J., Greenwood, D. A., Blanton, L., Bollinger, S. T., Butcher, M. K., Condon, J. E., … &
Kolb, L. E. (2018). 2017 National standards for diabetes self-management education and
support. The Diabetes Educator, 44(1), 35-50.
Brunisholz, K. D., Briot, P., Hamilton, S., Joy, E. A., Lomax, M., Barton, N., … & Cannon, W.
(2014). Diabetes self-management education improves quality of care and clinical
outcomes determined by a diabetes bundle measure. Journal of Multidisciplinary
Healthcare, 7, 533.