The nursing team has identified the opportunity to focus on poorly managed diabetic patients in a small, rural primary care practice with two full-time providers. The RNs are responsible for the assessment and education of diabetic patients. This project will help the RNs focus on assessing barriers, socio-economic factors, medication compliance, health literacy, and personal comprehension of managing diabetes to change teaching from a reactive to proactive method of teaching.

The intent of the nursing team is to implement a patient-centered diabetic teaching plan to empower our patient toward improved self-management of their diabetes. Through this proactive and sustainable teaching structure, the RN team will partner with this cohort of diabetic patients in changing teaching methods through increased health- coaching and communication within the nurse-patient relationship.

A literature search using multiple databases was conducted to find evidence-based articles on diabetic patients in rural areas. It was determined that understanding the barriers of rural diabetic patients would lead to best practice for improvement of patient's HgA1C. The prevalence of poor health literacy, socio-economic factors, access to care, and medication compliance are unique inequities within this population.

By assessing barriers of diabetic patients with a HgA1C of 9 or greater, the team has identified the opportunity to influence improvement in the management of diabetes through changes in our nursing clinical practice. A retrospective analysis of prospectively collected data was performed from January 2019 through April 2019. The team considered this to be high-risk diabetic patients. This analysis revealed 22 patients as having a HgA1C of 9 or greater.

The RN team designed a patient-centered, health literacy-appropriate, and culturally sensitive education plan for each patient, which included 1:1 diabetic teaching using the teach-back method and routine follow-up to improve self-management. Through this change in clinic practice and proactive approach to self-management, 20% of the high-risk patients will decrease their HgA1C to below 9 within 9 months.

Data analysis will be done at three-month intervals (September 30, 2019; December 31, 2019; March 31, 2020). September 2019 data has shown a significant improvement in this cohort of diabetic patients, with 68% of patients decreasing their HgA1C and 49% having met the goal of a HgA1C below 9. This project has improved nursing practice with diabetic patients and will continue through March 31, 2020.

Sheela Martel RN

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