NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal

NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal

NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal

Benchmark – Capstone Project Change Proposal Example

Background

Gestational diabetes is a new diagnosis of diabetes that occurs during pregnancy. Gestational diabetes occurs in about seven out of one hundred pregnant women (Medline, 2021). Gestational diabetes usually disappears once the infant has been delivered. Occasionally, women who have gestational diabetes may be diagnosed with diabetes mellitus type II after giving birth. In 2017, the national annual cost of gestational diabetes was $404 billion (Dall et al., 2019 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal). $13,240 was spent annually on one case of diagnosed diabetes and $4,250 on undiagnosed gestational diabetes (Dall, Yang, Gillespie, Mocarski, Byrne, Cintina, Hogan, 2019).

Gestational diabetes can complicate the pregnancy in a variety of different ways. For example, gestational diabetes can affect the delivery outcome, resulting in premature or cesarean delivery. The newborn may have complications as well as macrosomia, shoulder dystocia, and hypoglycemia (Camargo et al., 2021). Many risk factors may play a role in the mother’s diabetes during pregnancy. For example, the mother’s race may be a risk factor for gestational diabetes. Women who are African American, Hispanic, American Indian and Asian American have a higher risk of developing gestational diabetes (Mayo Clinic, 2020 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal).

Clinical Problem Statement

Diabetes is a common complication seen in the mom and baby unit. Mothers who have been diagnosed with gestational diabetes are likely to have complications intrapartum and postpartum, especially if the mother’s glucose is poorly controlled. One of the many intrapartum complications is diabetic ketoacidosis, which requires a hospital stay with many medical interventions like continuous intravenous fluids, continuous fetal monitoring, glucose monitoring and medication. Mothers require glucose monitoring every two hours for latent labor and every hour during active labor, some patients will require an insulin drip with the hourly point of care glucose monitoring (Banner WIS Clinical Education Team, 2019 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal).

Infants born to mothers with gestational diabetes are at an increased risk of having newborn hypoglycemia. Therefore, the newborn must undergo neonatal hypoglycemia protocol. The hypoglycemia protocol entails three point-of-care glucose testing if all results are within the normal range (Banner WIS Education Team, 2020). The point of care glucose testing involves a heel stick on the newborn. The heel stick is considered an invasive procedure. If the newborn is hypoglycemic, the newborn receives glucose gel and follow-up point-of-care glucose testing. Hypoglycemic newborns have higher chances of not being exclusively breastfed and receiving formula (Patel et al., 2020).

Purpose of the Change Proposal

The proposed change project will provide thorough education to women who plan to become pregnant, pregnant women, and women with preexisting risk factors or gestational diabetes. Women planning to get pregnant will be encouraged to have a pre-conception checkup with their physician to ensure all preexisting health conditions are under control. A preconception checkup is especially needed if the home has previously had a premature baby, a baby with a birth defect, a miscarriage, or stillbirth (March of Dimes, 2020 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal).

Education will be directed at reducing the modifiable risk factors, medication adherence, lifestyle changes like eating a healthy balanced diet and increasing physical activity. Providing the patient with education about eliminating modifiable risk factors before conception can allow the patient to prepare for the pregnancy and make the necessary lifestyle changes needed for a healthy pregnancy and positive patient outcome. Women diagnosed with gestational diabetes should maintain normal controlled glucose levels to reduce the risk of their newborns being affected.

A mother with gestational diabetes is considered controlled if her fasting blood glucose is under 100mg/dl and her Hba1C under 6.5% (Chohan et al., 2017 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal). Neonatal Hypoglycemia was most common in babies of uncontrolled diabetic mothers 66 (81.5%), while 15 (18.5%) neonates had hypoglycemia who were born to mothers with controlled diabetes during pregnancy (Chohan, Ahmed, Dass, and Shamim, 2017). Educating mothers on the complications of uncontrolled glucose throughout the pregnancy.

PICOT Question

In pregnancy (P), how does controlled glucose (I) compared to uncontrolled glucose (C) affect the newborn after delivery (T)? Uncontrolled blood glucose can affect the mother and the neonate if the mother’s glucose levels are uncontrolled. The complications can also affect the delivery outcome when a mother has uncontrolled blood glucose levels. For example, some complications that can occur are shoulder dystocia, vaginal lacerations, pre-eclampsia, pre-term birth, an emergency cesarean section, miscarriage or stillbirth (Centers for Disease Control and Prevention, 2019 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal).

Uncontrolled blood glucose levels may also affect the newborn. For example, newborns are at high risk for macrosomia, difficulty breathing, and obesity later in life (Mayo Clinic, 2020). The study conducted in 2017 by Chohan et al. showed that neonates born to mothers with uncontrolled glucose had increased issues with hypoglycemia and macrosomia. For example, 94.6% of male neonates had macrosomia and 92.3 % of male neonates had hypoglycemia who were born to mothers with uncontrolled glucose levels (Chohan, Ahmed, Dass, and Shamim, 2017).

Literature Search Strategy

While gathering resources for the capstone change project, multiple databases were used. The Grand Canyon University library was a great resource and had a lot of beneficial articles. Science Direct, GALE, ProQuest, PubMed, and DOAJ. The search terms used to search the Grand Canyon University library were gestational diabetes, uncontrolled glucose, newborn, neonate, and delivery outcome. The Mayo Clinic and The Centers for Disease Control and Prevention is an excellent resource with many of the complications that affect mothers and newborns. Articles that were published prior to 2017 were excluded. As well as articles that focused on other prenatal complications like hyperlipidemia and articles that were in foreign languages were excluded.

Evaluation of the Literature

The research questions from the resources that were chosen for the capstone change project all are focused on and questioned the mother’s glucose levels. The research questions questioned if interventions to control the mother’s glucose to decrease complications for the mother and newborn. The eight research questions also all focus on how the mother’s glucose levels affect the delivery outcome and how the newborn is affected. The Gray et al. (2020 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal) article questions varied differently from the other articles. The article is about the mother’s perceptions of the diagnosis of gestational diabetes mellitus will develop into type II diabetes without making lifestyle changes.

The Allehdan et al. (2019) article research question asked if making changes to diet or physical activity worked better to control the mother’s blood glucose levels. The Das (2017) article questions if the neonate has more complications with gestational diabetes or overt diabetes. The limitations of the eight chosen articles varied. For example, the article by Sabika et al. (2019 v) identified a limitation of the systematic review that could be related to different types of exercise and diets that were not in the included studies. Also, adherence to dietary interventions was not assessed or reported in five trials. The research done by Camargo,

Et al. (2021) used a sample population taken  from one resource that served the low-income population. In the article done by Gray et al. (2020), the limitation was identified; limitation of the survey they gave out to women to identify their subjective risk level of having diabetes that did not explain the meaning of what was classified as high risk, medium risk, or low risk. Another limitation they identified was that the patient’s weight was self-reported and women often underestimate their actual weight. Pooransari et al. (2021) study identified the limitation of the study as incomplete records. For example, no hemoglobin A1c test was performed. Shindo et al. (2021 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal) identified their limitation of the pregnant women in the control group may have had information on how to maintain a healthy diet and the physical activity they should be performing.

Nursing Theory

The nursing theory that applies to the Capstone change project is the Dorothy Orem Theory. The Dorothy Orem theory focuses on the activities that individuals perform on their own behalf. There are three components to the theory. The theory of self-care, self-care deficit, nursing system (Post University, 2021). The self-care theory encourages mothers to take charge of their health. Those actions are to maintain one’s life and functioning, develop oneself or correct a health deviation or medical condition (Post University, 2021).

The Dorothy Orem theory applies to the proposed evidenced based change project by encouraging mothers to improve their health by maintaining normal glucose levels throughout pregnancy. The theory of the nursing system emphasizes the relationship between the nurse and the client and the whole or partial compensatory nursing system and supportive- educative system that takes place between a nurse and a person (Post University, 2021 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal). This applies to the proposed theory by supporting the mother with the education to make the necessary lifestyle changes and/or glucose monitoring.

Proposed Implementation Plan

To implement the capstone change project, the patients will be provided with more thorough education and support on how to make healthy lifestyle modifications to reduce risk factors or prevent gestational diabetes. The education will be started prior to conception at a preconception evaluation. Women of child-bearing ages will be encouraged to attend preconception appointments with their physicians. Education will be provided at the mother’s obstetrics and gynecology appointments and in the hospital. The education provided will emphasize uncontrolled glucose’s effects on newborns to help increase maternal compliance with medications, glucose monitoring, diet, and physical activity.

A learning assessment will be completed to determine the patient’s learning style. Once the patient’s learning style is identified, education will be provided to the patient. Any barriers to lifestyle modifications will need to be identified and addressed to achieve success. The measured outcomes will be the mother’s blood glucose level, the delivery outcome, and the newborn complications.

Evidence-Based Practice

Evidenced-based practice was used in various ways while creating the capstone change project’s interventions. One of the interventions is the one-hour glucose testing.

The glucose tolerance test is used to screen for gestational diabetes. Pregnant women are supposed to get their one-hour glucose tolerance test during the 24^th and 28^th weeks of pregnancy (Mayo Clinic, 2020). If the glucose tolerance test is higher than 140mg/dl, it is recommended the mother gets a three-hour glucose tolerance test (Mayo Clinic, 2020 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal). Also, the education that will be provided to the mothers is all evidence-based.

Evaluation of the Proposed Nursing Intervention

The plan to evaluate the effectiveness of the proposed evidenced based project is to keep track of the women who are currently trying to conceive. A preconception check is vital for every woman to ensure all preexisting health conditions are controlled. A preconception checkup is especially needed if the home has previously had a premature baby, a baby with a birth defect, a miscarriage, or stillbirth (March of Dimes, 2020 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal).

Another way to evaluate the proposed change project’s effectiveness is to ensure the mother gets nutrition counseling and gets her glucose tolerance test done. Pregnant women are supposed to get their one-hour glucose tolerance test during the 24^th and 28^th weeks of pregnancy (Mayo Clinic, 2020). Also, keeping track of the rate of mothers who have gestational diabetes and record the delivery route and neonatal complications to see if the project is making a difference in the community.

Potential Barriers

Multiple barriers have been identified when planning the proposed evidenced based change project. Some of the barriers are the mother’s adherence to medications, lifestyle changes, cultural beliefs, lack of health literacy, and finances. The lifestyle changes needed for the proposed evidenced based change project depend on the mother’s adherence to the recommendations. Mothers diagnosed with gestational diabetes need to change their diet, check their glucose and take the medications as prescribed. Culture can influence the mother’s adherence to the proposed project’s interventions. Some ethnic groups have been associated with an increased risk of not adhering to recommended treatment (Chen et al., 2019 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal).

Lack of health literacy is also a factor in the implementation of the proposed change project. The lack of health literacy education is more prevalent in low-educated, rural, housekeepers and older-aged women (Pirdehghan et al., 2020 NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal). Finances can also affect the proposed change projects implementation. The lack of finances can be a problem. For example, some mothers have no insurance, are underinsured, or are impoverished. 13.6% of residents lack health insurance (Healthy Pima, 2020). Without insurance, many Tucsonans go without any medical care or are unable to pay for prescriptions or medical supplies.

NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal Resources

Allehdan, S. S., Basha, A. S., Asali, F. F., & Tayyem, R. F. (2019). Dietary and exercise interventions, glycemic control, and maternal and newborn outcomes in women diagnosed with gestational diabetes: Systematic review. Diabetes & Metabolic Syndrome, 13(4), 2775–2784. https://doi- org.lopes.idm.oclc.org/10.1016/j.dsx.2019.07.040

Banner WIS Clinical Education Team. (2019). Intrapartum Management of Diabetes (Rep.). Tucson, AZ: Banner Health.

Banner WIS Clinical Education Team. (2020). Gestational Diabetes. Tucson, AZ: Banner Health.

Camargo, Sávio F., Camargo, Juliana D., Schwade, Daniel, Silva, Raíssa M., Cornetta, Maria da Conceição M., Cobucci, Ricardo N., & Costa, Eduardo C. (2021). Movement Behavior during Pregnancy and Adverse Maternal–Fetal Outcomes in Women with Gestational Diabetes: A Pilot Case-Control Study. International Journal of Environmental Research and Public Health, 18(1114), 1114. https://doi- org.lopes.idm.oclc.org/10.3390/ijerph18031114

Centers for Disease Control and Prevention. (2019b, December 05). Influence of Acculturation on Risk for Gestational Diabetes Among Asian Women. Retrieved from https://www.cdc.gov/pcd/issues/2019/19_0212.htm

Chen, L., MD, Ph.D., Shi, L., Ph.D., Zhang, D., Ph.D., & Chao, S. M., MPH, Ph.D. (2019, December 05). Influence of Acculturation on Risk for Gestational Diabetes Among Asian Women. Retrieved from https://www.cdc.gov/pcd/issues/2019/19_0212.htm

Chohan, M. N., Ahmed, I., Dass, D., & Shamim, S. (2017). Diabetic Mothers; Frequency of Macrosomia and Hypoglycemia in Neonates of (Controlled Versus Uncontrolled). Professional Medical Journal, 24(12), 1–6. https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true &db=a9h&AN=127045030&site=eds-live&scope=site

Dall, T. M., Yang, W., Gillespie, K., Mocarski, M., Byrne, E., Cintina, I., Hogan, P. F. (2019).

The Economic Burden of Elevated Blood Glucose Levels in 2017: Diagnosed and Undiagnosed Diabetes, Gestational Diabetes Mellitus, and Prediabetes. Diabetes Care, 42(9), 1661-1668. doi:10.2337/dc18-1226

Dall, Yang, Gillespie, Mocarski, Byrne, Cintina, Hogan, (2019) https://care.diabetesjournals.org/content/diacare/early/2019/04/23/dc18-1226.full.pdf

Das, A. (2017). Maternal and perinatal outcomes in diabetic pregnancies at BPKIHS. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6(6), 2262. http://dx.doi.org.lopes.idm.oclc.org/10.18203/2320-1770.ijrcog20172115

Gray, K. L., McKellar, L. M., O’Reilly, S. L., Clifton, P. M., & Keogh, J. B. (2020). Women’s Barriers to Weight Loss, Perception of Future Diabetes Risk and Opinions of Diet Strategies Following Gestational Diabetes: An Online Survey. International Journal of Environmental Research and Public Health, 17(24). https://doi- org.lopes.idm.oclc.org/10.3390/ijerph17249180

Healthy Pima. (2020, March 6). Community Wellbeing. Retrieved September 5, 2020, from https://www.healthypima.com/community-database

March of Dimes. (2020, September). Your checkup before pregnancy. Retrieved from https://www.marchofdimes.org/pregnancy/your-checkup-before-pregnancy.aspx

Mayo Clinic. (2020, August 26). Gestational diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms- causes/syc-20355339

Medline. (2021, May 27). Gestational Diabetes. Retrieved from https://medlineplus.gov/diabetesandpregnancy.html

Patel, P., Gogoi, P. R., Deb, S., Paul, P., Yesmin, S., Jamir, L. S., & Paharia, P. (2020).

Hypoglycemia in Exclusively Breastfed High-Risk Neonates – A Hospital-Based Study. International Journal of Pediatric Research, 6(2). doi:10.23937/2469- 5769/1510066

Pirdehghan, A., Eslahchi, M., Esna-Ashari, F., & Borzouel, S. (2020, February). Retrieved from https://www.researchgate.net/publication/339621511_Health_literacy_and_diabetes_cont rol_in_pregnant_women

Post University. (2021, March 15). Dorothea Orem: Pioneer of the Self-Care Nursing Theory. Retrieved from https://www.americansentinel.edu/blog/2020/07/11/dorothea-orem- pioneer-of-the-self-care-nursing-theory/

NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal

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.

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.

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:

• Background
• Problem statement
• Purpose of the change proposal
• PICOT
• Literature search strategy employed
• Evaluation of the literature
• Applicable change or nursing theory utilized
• Proposed implementation plan with outcome measures
• Identification of potential barriers to plan implementation and a discussion of how these could be overcome
• 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. NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal

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

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

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

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NRS490 Week 12 Assignment Benchmark: Professional Capstone and Practicum Reflective

Students must maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.

In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:

• New practice approaches
• Intraprofessional collaboration
• Healthcare delivery and clinical systems
• Ethical Considerations in health care
• Population health concerns
• The role of technology in improving health care outcomes
• Health policy
• Leadership and economic models
• Health disparities

Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide located in the Student Success Center. NRS490 Week 11 Assignment Benchmark Capstone Project Change Proposal

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

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.