Week 6 Assignment: Examine Multicultural Issues Related to Substance Abuse and Addiction

Application of Innovation

Abstract
The promotion of optimum outcomes among patients suffering from chronic illnesses such as diabetes is important in nursing practice. Therefore, this paper proposed the use of mobile apps in the practice site to promote diabetes self-management. The anticipated outcomes include reduction in care costs, emergency department visits, hospitalization rate, and diabetes-related complications. The project will adopt PDSA model of quality improvement. Interprofessional teams will be involved in the implementation of the project.

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Application of Innovation
The promotion of optimum health outcomes is crucial in nursing and healthcare. Public health issues such as diabetes have immense impact on the health and wellbeing of the global populations. Diabetes currently ranks the top ten of the leading causes of mortalities in the United States. Nurses and other healthcare providers play a crucial role in ensuring the adoption of evidence-based treatments that will optimize outcomes among the populations affected by diabetes. The interventions aim at ensuring care outcomes such as safety, quality, and efficiency. DNP nurses drive change in their practice settings and communities. They explore innovative practices that can be translated into practice to address the existing barriers to access to healthcare for the different populations. Therefore, the purpose of this paper is to explore a system that can be adopted to address diabetes in the practice site. The topics discussed in this paper include systems thinking, informatics and clinical judgment, quality improvement framework, organizational characteristics, interprofessional collaboration, and healthcare policy.
Systems Thinking, Informatics and Clinical Judgment
System Description
The practice site is a tertiary institution that leads in the provision of high-quality services in the region. It provides general and specialized care services to its populations. It recently ranked among the top five hospitals in the provision of safe, efficient and patient-centered care in the region. The care teams utilize interprofessional collaboration to optimize outcomes such as safety, quality, and efficiency for their populations. The organization has witnessed a sharp rise in the population affected by diabetes. There has also been a high number of diabetic patients being re-hospitalized frequently because of complications such as hypoglycemia, hyperglycemia, and diabetic foot. Despite the rise, the management has not explored the need for the adoption of an evidence-based intervention to address the issue in the population. Therefore, it is proposed in this paper that the organization should adopt mobile applications to aid in diabetes self-management and optimum glycemic control among the affected populations.
According to the Healthy People 2030, more than 30 million people in America have diabetes. Diabetes currently ranks as the seventh leading cause of mortalities in the United States. Healthy People 2030 also identifies the existence of significant disparities in the populations affected by diabetes. Individuals from ethnic minority groups are more likely to have diabetes than the ethnic majority groups (health.gov, 2023). Sadly, most of the Americans do not know they are either diabetic or prediabetic. For example, the Centers for Disease Control and Prevention (CDC) reports that about 8.5 million adults with diabetes are undiagnosed (CDC, 2022).
As noted above, the identified system for use in addressing the rising rates and complications of diabetes being reported in the organization is the use of mobile phone applications. Mobile phone applications can be used to promote diabetes self-management by patients and their significant others. The applications can be used to deliver targeted health education messages to the patients on diabetes management, glucose monitoring, and management for optimum glycemic control (Gong, Baptista, et al., 2020; Gong, Zhang, et al., 2020). The applications also provide automated data to the healthcare providers about the glycemic levels o their patients. The use of the application entails patients entering their data into the applications and using them to transmit information virtually. They receive feedback from their care providers as well as the automated systems (health.gov, 2023). The effective use of the mobile apps facilitates timely communication between patients and healthcare providers, glycemic control, patient empowerment, and satisfaction with care.
The need for adopting mobile apps for use in diabetes self-management stems from the increase in the number of diabetic patients in the organization and high re-hospitalization rate due to diabetes-related complications. According to Healthy People 2030, poorly controlled or untreated diabetes leads to complications such as foot or leg amputations, renal damage, and retinopathy (health.gov, 2023). Patients also develop additional complications such as diabetic ketoacidosis, hyperglycemia, and hypoglycemia. Poorly controlled diabetes increases the costs of healthcare that patient and families incur (Gong, Baptista, et al., 2020). The rise in costs is attributed to frequent hospitalizations and complex care that they experience.
There is also the loss of productivity due to missed work, loss of productivity, and premature deaths. Patients also suffer from the decline in the quality of life secondary to their inability to perform optimally in their social and occupational roles. However, interventions such as the use of mobile applications can reduce the risk of complications and improve quality of life among patients affected by diabetes (Adu et al., 2019; health.gov, 2023). The intervention can also help prediabetics and those without diabetes to embrace healthy lifestyles and behaviors that eliminate the risk of diabetes and other chronic illnesses.
The adoption of mobile applications for use in diabetes self-management also aims to improve outcomes in the organization. First, it seeks to promote cost-efficiency. The use of mobile apps for diabetes self-management has been shown to improve glycemic control. This minimizes the risk of diabetes-related complications that account for high costs that patients and healthcare organizations incur because of frequent hospital visits and hospitalizations. A reduction in the hospital visits and hospitalizations will ensure cost-efficiency in the organization (Boels et al., 2019). The mobile apps will also promote the delivery of patient-centered care to the patients with diabetes and their families. The apps allow timely and virtual interaction between patients and their healthcare providers, which helps in the early detection and management of problems in the disease treatment process (Kusnanto et al., 2019). Consequently, the organization anticipates an increase in patient satisfaction, engagement, and empowerment rate in diabetes management and prevention.
Quality Improvement Framework
Quality improvement frameworks may be incorporated into the proposed change in the practice site. In specific, the Plan, Do, Study, and Act (PDSA) model will be adopted. The PDSA model is a tool that helps organizations to improve the quality of their services and products. The model offers systematic steps that change implementer utilize to acquire valuable learning and knowledge on the effectiveness of the adopted change in improving organizational systems and or processes (Katowa-Mukwato et al., 2021). The model emphasis is on a cycle that starts with planning, developing and implementing steps needed for improvement, studying results to identify successful strategies and needed improvements, and incorporating them into the next processes to enhance outcomes.
The Plan step in the PDSA model entails the identification of a goal or objective for the change. For this case study, it would be the reduction of hospital visits and hospitalization rate of patients with diabetes in the practice site. The development of an action plan followers where measures or metrics of success are established. The Do step is characterized by the implementation of the developed strategies for the change. Often, change implementers explore strategies such as interprofessional collaboration, active stakeholder engagement, open communication, and providing feedback to increase the success rate in the implementation phase (Zhou & Zhang, 2022). The Study step in the model entails the monitoring of the implementation outcomes. The change stakeholders measure the outcomes against the set benchmark data to determine the effectiveness of the change initiative. They also obtain feedback from the adopters of the change to learn more about the change aspects that were either successful or unsuccessful. The feedback data informs the improvement strategies for the change initiative. The last step is the Act phase where the implementers of the change incorporate the feedback from the study step into the learning (Ogrinc et al., 2021). The focus is on strategy revision and re-adjustment to ensure the organization achieves its desired goals and objectives in reducing the rate and risk of medication errors.
The PDSA model is appropriate for the proposed change because of several reasons. First, it will enable the practice site to build the proposed change on best practices. The utilization of processes such as studying the change will enable the organization to identify best practices that produce the desired results in the change process. The model also allows the systematic implementation of a change in the organization. This is important in building the desired confidence in using the change by the healthcare providers. The effective use of the change is also likely to ensure sustained change in the organization (Katowa-Mukwato et al., 2021). For example, the consistent use of best and successful strategies in the implementation of the proposed change will ensure change ownership, hence, its sustainability in the organization.
PDSA Template

Plan
What are we testing in PDSA? Effectiveness of mobile apps on diabetes care outcomes.
Who is in charge? Nurses, nurse managers, nurse leaders, and IT officers
Predicted outcomes? Reduction in hospitalization rates, costs, and complications of diabetes
Timeline: six months
Data collected? Diabetes hospitalization rates and healthcare costs

Do
What will happen in implementation? Staff training, coaching, mentorship, and seeking feedback
How will evaluation be done? Supervision of mobile apps use and obtaining patients and nurses’ feedback

Study
Record and analyze data
Compare outcomes with prediction
Develop conclusions based on outcomes

Act
Modify the intervention
Develop recommendations
Disseminate outcomes

Organizational Characteristics
The practice site is ready to implement the proposed change. An organizational readiness assessment performed on the organization revealed that the organization has an enabling culture for change. The culture is characterized by teamwork, open communication, transparency, and accountability. The existence of care approaches such as interprofessional collaboration will ensure collectivism in the implementation of the proposed initiative. Open communication will strengthen the trust and honesty among the targets of the change and implementers. The organization values transparency in its systems and processes. It informs the healthcare providers about the needed changes, outcomes, objectives, and strategies to be adopted for their readiness. It also provides regular feedback to them to inform their behaviors (Dorow et al., 2019). The transparency is crucial in that it builds the desired trust among healthcare providers, hence, minimum resistance to change.
The organization has several strengths that support the adoption of mobile apps for diabetes self-management. One of them is the supportive leadership and management. The organizational leadership and management have always been in the forefront in supporting initiatives that address the organization’s needs. They advocate for the required resources and provide the supervision for successful change. They also monitor the adoption of the change process and provide crucial feedback needed for the successful adoption of a change (Stanley et al., 2022). The other organization’s strength is a highly skilled workforce. The organization has a highly skilled workforce that can support the proposed change. For example, most of the healthcare providers are highly competent in the use of different technologies in the provision of patient care services. The skilled workforce will translate into minimal resistance from them towards the use of mobile apps to enhance diabetes management outcomes.
The other organization’s strength is the existence of a culture of patient safety. The organization has put in place systems, mechanisms and processes that aim at optimizing safety outcomes in the patient care processes. For example, it regularly trains its staff on the utilization of best practices in the care processes and translation of evidence-based practices into their roles for patient safety (Stanley et al., 2022). The proposed adoption mobile apps for diabetes self-management aligns with the organization’s focus on a culture of patient safety, hence, the high potential for its support.
The adoption of the proposed innovation may face some barriers. One of them is the competing needs in the organization. The organization currently has several projects that require intensive resource investments. This creates competing needs, which may affect the adequacy of the organizational support towards the adoption of the initiative. The proposed change will also require resources such as the acquisition of mobile apps, staff training, and supervision, which may be expensive now because of the competing needs. The other potential barrier may be the legal and ethical issues associated with technology use in healthcare. Technology use should ensure the protection of data integrity and assurance of high quality and safe care to the patients. The promotion of these outcomes with technology use may require changes in the existing systems and processes, hence, acting as a barrier to the proposed change. Lastly, the staff in the organization may not be willing to adopt the use of the system in diabetes care. Their reluctance may be attributed to factors such as fear of unknown outcomes such as the increased workload and lack of knowledge and skills on using the system (Huston, 2022). Therefore, anticipatory strategies will be adopted to minimize the occurrence of these barriers.
Data Analytic of Outcomes
The data on diabetes hospitalization rates and emergency department visits among diabetic patients will be collected and analyzed monthly in the organization. The data will be collected and stored in Microsoft Excel. The outcomes of focus will include mortality rate, cost of care, hospitalization and emergency department visits rate among diabetic patients. Nurse leaders, informaticists, managers, and nurses will also be surveyed to obtain data about their experiences with the use of mobile apps for diabetes self-management. They will provide insights into the strengths, weaknesses, and opportunities that should be explored to fully optimize on the benefits of the technology in diabetes management. The data will be analyzed and compared with those obtained before the adoption of mobile apps. A decline in hospitalization rates, hospital visits, complications, and cost of care following the adoption of mobile apps will be considered its success and vice vasa.
Interprofessional Collaboration
Interprofessional teams will be applied in the implementation of the innovation in the organization. Accordingly, professionals that include nurse informaticists, nurses, nurse leaders and managers, physicians, and information technology experts will be involved. They will play unique roles needed for the success of the implementation process. Nurse informaticists have extensive knowledge and experience in the use of healthcare systems in the provision of innovative care services. Their role will be crucial in ensuring the adoption of mobile apps for diabetes self-care. They will also guide in the selection of evidence-based strategies that will eliminate the potential or risk of resistance to the change process by the adopters. Nurses will be primarily involved in using the technology for diabetes care. They should be involved in the entire processes of change implementation (Huston, 2022; Stanley et al., 2022). This includes needs analysis, planning, implementation, monitoring, and evaluation.
Physicians will also utilize the system in diabetes care. Their involvement in the process will be important to ensure the adoption of a system that aligns with their needs and experience. They are also crucial in ensuring the efficient use of the system in diabetes care. The proposed initiative leverages on the use of health information technologies to improve care outcomes. As a result, an information technology expert should be included in the process (Stanley et al., 2022). The expert will provide the technical support needed in the implementation process of the change and ensuring its sustainability in the organization.
Nurse leaders and managers will also be needed for the success of the change. They will advocate for the resources needed for the change alongside providing the supervision for the success of the process. They will also act as coaches, mentors, and obtain feedback from nurses about their experiences with the technology use in diabetes care (Huston, 2022). Therefore, collaboration among these professionals will be essential for the overall success in the use of mobile apps to enhance diabetes care outcomes and self-management.
Health Policy
The adoption of mobile apps for diabetes self-care supports the Patient Safety and Quality Improvement Act of 2005. The Patient Safety and Quality Improvement Act is a policy that was adopted to improve the overall safety of care given to patients and reduce events associated with potentials of harm to the patients. The act authorized the creation of patient safety organizations tasked with the roles of improving safety and quality by collecting and analyzing confidential, aggregated data related to patient safety events. The act also required the AHRQ to come up with effective strategies that health organizations can utilize to increase patient safety and reduce medical errors. Consequently, healthcare providers and organizations were encouraged to be proactively involved in their capacities in identifying evidence-based interventions to prevent medical errors (Ahrq.gov, n.d.). The proposed innovation supports the Public Safety and Quality Improvement Act of 2005 by enhancing the use of safe, efficient technologies to achieve safety and quality outcomes in health. It also seeks to transforms the existing systems and processes for the optimization of patient care outcomes. The innovation also supports the Affordable Care Act (ACA) by addressing barriers to healthcare for those in need. The use of mobile apps for diabetes self-management addresses barriers to diabetes care such as high costs by reducing unnecessary expenses in vising healthcare facilities for diabetes care. As a result, there will be expanded access to diabetes care, hence, equitable access to healthcare for all.
Conclusion
In conclusion, the issue of concern in the practice site rising number of patients with diabetes and high re-hospitalization rate due to diabetes complications. As a result, it is proposed that the adoption of mobile apps for diabetes self-care will solve the problem. The PDSA model of quality improvement will guide the implementation process. Interprofessional teams will be involved in all the processes of the project. The proposal seeks to enhance the realization of the safety goals set by the Patient Safety and Quality Improvement Act of 2005 and expanded access to care as envisioned in the Affordable Care Act.

References
Adu, M. D., Malabu, U. H., Malau-Aduli, A. E. O., & Malau-Aduli, B. S. (2019). Enablers and barriers to effective diabetes self-management: A multi-national investigation. PLOS ONE, 14(6), e0217771. https://doi.org/10.1371/journal.pone.0217771
Ahrq.gov. (n.d.). Patient Safety and Quality Improvement Act of 2005 | PSO. Retrieved February 27, 2023, from https://pso.ahrq.gov/resources/act
Boels, A. M., Vos, R. C., Dijkhorst-Oei, L.-T., & Rutten, G. E. H. M. (2019). Effectiveness of diabetes self-management education and support via a smartphone application in insulin-treated patients with type 2 diabetes: Results of a randomized controlled trial (TRIGGER study). BMJ Open Diabetes Research and Care, 7(1), e000981. https://doi.org/10.1136/bmjdrc-2019-000981
CDC. (2022, June 29). National Diabetes Statistics Report | Diabetes | CDC. https://www.cdc.gov/diabetes/data/statistics-report/index.html
Gong, E., Baptista, S., Russell, A., Scuffham, P., Riddell, M., Speight, J., Bird, D., Williams, E., Lotfaliany, M., & Oldenburg, B. (2020). My Diabetes Coach, a Mobile App–Based Interactive Conversational Agent to Support Type 2 Diabetes Self-Management: Randomized Effectiveness-Implementation Trial. Journal of Medical Internet Research, 22(11), e20322. https://doi.org/10.2196/20322
Gong, E., Zhang, Z., Jin, X., Liu, Y., Zhong, L., Wu, Y., Zhong, X., Yan, L. L., & Oldenburg, B. (2020). Quality, Functionality, and Features of Chinese Mobile Apps for Diabetes Self-Management: Systematic Search and Evaluation of Mobile Apps. JMIR MHealth and UHealth, 8(4), e14836. https://doi.org/10.2196/14836
health.gov. (2023). Diabetes—Healthy People 2030 | health.gov. https://health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes
Dorow, P. F., Da Silva, C., Huhn, A., Borges, L. M., Da Nóbrega, J. F., Andrade, M. A., Machado, C. N., Do Prado, R. A., & Ribeiro, G. (2019). Practices of knowledge management in health organizations. Revista ESPACIOS, 40(24). http://w.revistaespacios.com/a19v40n24/19402402.html
Huston, C. J. (2022). Leadership Roles and Management Functions in Nursing: Theory and Application. Lippincott Williams & Wilkins.
Katowa-Mukwato, P., Mwiinga-Kalusopa, V., Chitundu, K., Kanyanta, M., Chanda, D., Mbewe Mwelwa, M., Ruth, W., Mundia, P., & Carrier, J. (2021). Implementing Evidence Based Practice nursing using the PDSA model: Process, lessons and implications. International Journal of Africa Nursing Sciences, 14, 100261. https://doi.org/10.1016/j.ijans.2020.100261
Kusnanto, Widyanata, K. A. J., Suprajitno, & Arifin, H. (2019). DM-calendar app as a diabetes self-management education on adult type 2 diabetes mellitus: A randomized controlled trial. Journal of Diabetes & Metabolic Disorders, 18(2), 557–563. https://doi.org/10.1007/s40200-019-00468-1
Ogrinc, G., Dolansky, M., Berman, A. J., Chambers, D. A., & Davies, L. (2021). Different approaches to making and testing change in healthcare. BMJ, 374, n1010. https://doi.org/10.1136/bmj.n1010
Stanley, D., Bennett, C. L., & James, A. H. (2022). Clinical Leadership in Nursing and Healthcare. John Wiley & Sons.
Zhou, X., & Zhang, D. (2022). A conceptual model to manage multiple chronic conditions based on PDSA theory [Preprint]. In Review. https://doi.org/10.21203/rs.3.rs-1691911/v1

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For this task, imagine that you were asked to prepare a presentation at your local public health center to increase their multicultural awareness of substance use disorder. You will address physicians, nurses, social workers, and public health workers. Differentiate the causes, course of substance use disorder, and other factors that influence drug use in at least three ethnic groups. Be sure to note differences between men and women in general, and within these various subgroups.

You may choose the format for this presentation; and you may prepare a recorded lecture with an accompanying transcript of the lecture, a PowerPoint presentation, or a written lecture.

Length: Written Lecture: 5-7 pages or PowerPoint Presentation: 12-15 slides with 100 to 150-word notes per slide or a recorded lecture between 3 to 5 minutes.

Resources: Your presentation should draw on the resources listed for this week, as well as 3 three articles published in peer-reviewed journals in the past 5 years. In addition to these specified resources, other appropriate scholarly resources, including older articles, may be included.

If you choose to record your lecture, upload it to your instructor in MP3 format; this file must not exceed 8mb. An average lecture tends to be 100 to 150 words per minute. There are many audio recording programs available. Audacity is an open-source recording program available on the Internet. The instructions for using audacity are located under your weekly resources.

Your presentation should demonstrate thoughtful consideration of the ideas and concepts presented in the course by providing new thoughts and insights relating directly to this topic. Your response should reflect scholarly writing and current APA standards. Be sure to adhere to Northcentral University’s Academic Integrity Policy.