NURS FPX 4905 Assessment 2 Define and Analyze Your Healthcare Process Problem or Issue of Concern

Define and Analyze Your Healthcare Process Problem 

or Issue of Concern

Student name

Capella University

NURS-FPX4905

Professor Name

Submission Date

Define and Analyze Your Healthcare Process Problem or Issue of Concern

I have 40 hours of service experience at the UnityPoint Health system, working at the 204-bed multidisciplinary endocrinology unit of the Allen Hospital, located in Waterloo, Iowa. The HbA1c and readmission rates amongst African American patients in this environment are significantly higher in the first 30 days of management, which argues in favor of the lack of diabetes self-management education (DSME). It discusses how haphazard, culturally insensitive DSME contributes to poor blood glucose control, which affects patient safety, quality care, and spending metrics of the organization (Camargo-Plazas et al., 2023). In order to discuss these issues, I am going to discuss: the description of the site and the patients who work there; the summary of the decision-making process and my role within it; the problem of the diabetes self-management education (DSME) procedure and its connection to the Type 2 diabetes outcomes; the analysis of the effects associated with it in relation to quality, safety, and costs; the review of the recent research and a conclusion with the recommendations and methods of evaluation.

Practicum Site Description

UnityPoint Health, Allen Hospital is a community hospital located in Waterloo, Iowa, and it contains 204 beds and is the busiest acute-care medical institution in the Cedar Valley region. Coupled with UnityPoint Health, the caregiver of a third of the patients in Iowa, Allen Hospital unites local, community care with those of the largest health net of the state. The endocrinology service in the hospital deals with a population of individuals who have numerous backgrounds. The uncontrolled Type 2 diabetes occurs more frequently in the African American population of Black Hawk County, which ranges between 9 and 10 percent (Gu et al., 2023).

The ward regularly takes care of the adults who have not managed their diabetes well and are overweight, have high blood pressure, and poor kidney issues. The median household income of the residents in this community is approximately 64,500, which indicates food insecurity, challenges in accessing primary care, and a lack of enough financial resources, which make it challenging to have confidence in the healthcare system and address health-related problems in the most appropriate way.

The Waterloo area has a population of nearly 1,100 clinicians and specialists and approximately 350 full-time RNs, five board-certified endocrinologists, four CDE nurses, and a variety of dietitians, pharmacists, social workers, and community health workers comprising the diabetes team in this area. The endocrinology unit leadership team is comprised of a nurse manager, quality specialist, and Dr. Alisha Engel, DNP, coordinator of the diabetes program, who is my preceptor at this facility. Due to these individuals and their organization, the region is better placed to manage the cases of Type 2 diabetes, which are on the rise.

Clinical & Operational Decision-Making

The management of sugar levels and the organization of education of patients is also the key to endocrinology unit decisions. Each day, an endocrinologist, a charge nurse, a pharmacist, a dietitian, and diabetes educators convene as a group to review and adjust insulin administration and recommend the start or increase of GLP-1 receptor agonists in patients during so-called glycemic rounds. In case of the social or behavioral barriers, they, as a team, assess the necessity of consultations with dieticians, social workers, or certified diabetes educators and determine whether the DSME will be provided in person or via the secure virtual-coaching application (Virlan et al., 2024).

My three roles in this workflow will include: (1) assisting patients with Type 2 diabetes and DSME in taking medicine, eating and testing blood sugar levels more effectively; (2) taking weekly notes about SMBG outcomes and current HbA1c levels and discussing them with the team in the huddles which will often lead to changes in the care plan; and (3) making a contribution to a clinically specific care plan dedicated to African-American adults with Type 2 diabetes. Clinicians will obtain reports summarizing the effectiveness of their decisions and work done in the field of education by following the results in the form of post-discharge HbA1c, rehospitalization in case of severe blood sugar levels, ER visits, and the confidence of patients in their homes.

Process Issue Identification

The issue is that the diabetes self-management seminars observed in Allen Hospital in the endocrinology department are vastly different and do not cater to the cultural needs of their African American Type 2 diabetes patients. Only a little more than half of the inpatients who had the opportunity to do so completed the entire diabetes curriculum as prescribed by the American Diabetes Association (ADA), and a single one out of four African American patients did the course (Dietz et al., 2022).

This way, post-group HbA1c levels (above 9 percent), 30-day readmission (15) rates of diabetes, which are significantly lower than the national average (101), and relatively invariably low self-care scores on the hospital review, are left (Skouri, 2023). Avoidable readmissions and extended hospitalizations imply a fine of up to 1.3 million a year on staff and care supplies utilized and not reimbursed (Hirani et al., 2025). The lack of sufficient DSME can be the reason why patients fail to take their medications, which in turn leads to excess sugar concentrations in the blood and predisposes them to micro- and macro-vascular complications, frequent emergency department visits, and repeated hospitalizations.

Impact Analysis

Failure to implement DSME on a regular basis and failure to standardize the approach influence all spheres of the endocrinology unit to the detriment. Standards and reality have big disparities, particularly with regard to care transitions, which are found to be eight points lower than the average med-surg score, according to chart reviews. In terms of safety, hypoglycemia incidents occur 2.1 times each 1000 patient days (target is [?] 0.8); patients simply do not receive the education on how to act when they become ill (Hirani et al., 2025). Due to these problems, patients spend more days in the hospital, skip numerous doses of insulin, and receive punishments from CMS. Three shifts are identified with four CDEs through a fishbone probe, which is not a sufficient culturally relevant resource, optional EMR referrals, and social issues, such as people not having enough to eat. They discovered that this causes a significant issue: there is no culture-appropriate method of using DSME, and with no delays reported in EMR, which has been reported in the literature to increase diabetes complications and admissions by 0.5-1 percent on average (Enricho Nkhoma et al., 2021).

The 2024 ADA Standards of Care introduces diabetes self-management education and support (DSMES) as one of the required Level As, and it is proposed that notifications should be provided via electronic records to ensure that more than 80 percent of the patients go through the process (Chinelo Nsobundu et al., 2024). According to the research, the nation has to reach the desired result: non-Hispanic blacks continue to experience the worst level of poor glycemic control and conditions (Shenoy et al., 2024). There is solid support for matching programs to cultures. In one of the 2022 trials, an African American adult race-congruent peer-supported DSME gave participants a mean decrease of 1.2 percentage points in their HbA1c after six months (Shiyanbola et al., 2022).

A 2023 investigation that gathered information on nine recent studies affirmed the results and indicated a 0.5-1.0 percent reduction in HbA1c and enhanced adherence to medications with such curricula (Ehrhardt et al., 2025). In the UnityPoint Health organization, a test conducted recently revealed that when physicians implemented the hard-stop form of cardiac rehab, EMR referrals increased by 35 percent, and more people completed their program. Finally, the Institute of Healthcare Improvement implements the teach-back at all times with its Always Use Teach-Back, which helps learners to ensure that the transition process is smooth and that the benefits of DSME are retained.

Evidence Synthesis

Available research can provide clear insight into the solution to the DSME problem at Allen Hospital. The American Diabetes Association recommends it as one of the priorities of people with diabetes, which should be offered automatically upon diagnosis, once a year, and whenever they lose glycemic control (American Diabetes Association, 2024), and the goal is 80 percent completion. The national surveillance of the CDC (2024) revealed that the non-Hispanic Black adults in the US have the highest level of poorly controlled diabetes and hospital admissions, thus proving the importance of good education to everyone. Clinical trials showed beneficial outcomes in the case of DSME that was culturally shaped to demonstrate better HbA1c and attendance among African Americans (Ewen et al., 2024).

A UnityPoint Health quality improvement initiative (2024) consisting of the implementation of a hard-stop of DSME referrals in EHR led to a 35 percent growth in the number of patients receiving the cardiac-rehabilitation program without the necessity to employ more personnel (Sangani et al., 2021). It is also validated by the Institute of Healthcare Improvement fact sheet, its “Always Events, Teach-Back” toolkit (2021), which aims to make sure there is understanding of the treatment to be provided to the patient on his/her visit (Sangani et al., 2021). This strategy will help Allen Hospital to directly help in increasing the confidence levels of patients when it comes to managing their own health. The combination of the strategies will provide a structured intervention plan, EHR alert referral, relatable courses, peer coaching, and necessary teach-back, to address the problem of low completion rate of DSME in the hospital, high rates of readmission, and patient HbA1c levels that were too high both pre- and post-discharge.

Conclusion

Coordinating a culturally appropriate self-management diabetes approach in the Allen Hospital is key to eliminating the broad glycemic-control disparity observed among African-American Type 2 diabetics. The team is able to achieve the ADA standards of DSME, decrease low blood sugar incidences, and prevent over a million dollars of unneeded hospital admissions with the assistance of EMR rules, more educators, and more meaningful materials to the patients.

These measures directly contribute to the hospital by improving its quality, safety, and cost rates and also prioritize health equity, which is a requirement in contemporary nursing. Because of undertaking such analysis, I am in a better position to understand organizational data, synthesize all existing evidence, and propose new approaches that would enhance processes, which are skills all evidence-based, equity-oriented nurse leaders should possess.

For the first assessment of this class, visit: NURS FPX 4905 Assessment 1