Diabetes mellitus is a life-threatening condition the prevalence of which reaches concerning levels in older adults. Patients diagnosed with diabetes have a high risk of a wide-range of acute and chronic conditions and complications (“About diabetes,” 2017; Draznin, 2016). Taking into consideration the increasing number of older adults with the homebound status, it is of utter importance to develop effective patient education programs to increase their disease management capacity (Pender, Murdaugh, & Parsons, 2014). This paper will outline an education plan for homebound elderly with diabetes. The plan aims to reinforce the population’s understanding of the condition and improve their self-care behaviors.
A report issued by Centers for Disease Control and Prevention reveals that more than 30 million Americans have been diagnosed with type 2 diabetes (as cited in Draznin, 2016). Out of this number, more than 20 million are adults who are 65 and older, which represents a 24 percent increase from 2003 (Draznin, 2016). The increase can be attributed to changing patterns of life expectancy in the US. Unfortunately, the condition diminishes the lifespan of afflicted individuals by 7.9 years on average (Holt, 2015). It follows that older individuals are disproportionately targeted by a disease, which is associated with numerous self-care challenges.
Currently, there are more than 7 million Americans with the homebound status (Barrett, Lawler, & Kyle, 2015). Approximately 30 percent of these individuals have diabetes, which further complicates the management of the condition (Barrett et al., 2015). Therefore, home care nurses should take decisive steps for improving health outcomes of their patients.
The transtheoretical model (TCM) will be used to plan an educational program for homebound older adults with diabetes. The model will help to understand stages progressed by patients during the process of their behavior modification. The application of the model will help the home care nurse to encourage positive behavioral changes through each of its steps—pre-contemplation, contemplation, action, and maintenance (Sharma & Romas, 2012). The model is closely aligned with Kurt Lewin’s change theory, which includes three sequential phases: unfreezing, moving, and refreezing (Asiri, 2015). The work site is an institution that specializes in the delivery of healthcare services to homebound patients. Taking into consideration specific characteristics of the homebound population, lectures will be used as an educational method. However, the information provided in the lecture format will be reinforced with the help of handouts.
Education for homebound patients with diabetes will be tailored to their specific needs in order to ensure that information is properly processed. Therefore, fees charged for the program can be determined based on both individual needs of patients and whether their insurance providers reimburse this type of educational sessions.
The plan presupposes five home-delivered educational meetings consisting of lectures and Q&A sessions.
- Day 1. The first lecture will cover general information about diabetes. Older adults with the homebound status are more likely to experience impairment of their cognitive function, hearing, and vision than their counterparts (Birchenall & Streight, 2014). Therefore, the lectures will be personalized to account for those discrepancies.
- Day 2. During the second lecture, the population will be informed about oral diabetic agents and administration of insulin. In addition, the older adults will be familiarized with key symptoms of hypoglycemia and hyperglycemia as well as basics of glycemic control (Holt, 2015).
- Day 3. The third lecture will be used to teach the homebound patients blood glucose monitoring methods.
- Day 4. The fourth lecture will educate the population on complications from the condition, foot care, and exercise (Holt, 2015). The majority of homebound patients are either bedbound or use walkers and canes (Barrett et al., 2015). Therefore, only those patients whose mobility is not restricted will be provided with information on low-intensity exercise and its cardiorespiratory and weight loss benefits.
- Day 5. The fifth lecture will cover nutrition and coping methods. The management of the disease presupposes a nutritional intervention; therefore, the older adults will be provided with information on “carbohydrate counting, portion control, and meal spacing” (Weinger, Beverly, & Smaldone, 2015, p. 1274).
The inability of patients to leave their environments and social isolation, which is a natural corollary of their homebound status, are the most significant barriers to successful diabetes management. Other hindrances are a lack of motivation, cardiovascular complications, and cognitive deficits. External barriers such as mediation costs can also impact the success of the educational intervention (Weinger et al., 2015).
The effectiveness of the program can be assessed with the help of standardized questionnaires that will be delivered to patients who were exposed to five educational sessions. In addition, the nurse can evaluate the impact of the educational intervention by measuring the patients’ waist to hip ratio and changes in their hemoglobin A1c (Draznin, 2016). Cluster randomization will help to ensure that the blindness of the population sample is not compromised during the assessment phase.
The paper has outlined an education plan for homebound elderly patients with the homebound status. The plan aims to increase the population’s awareness about the condition and improve their ability to engage in self-care behaviors. TCM will be used to support the planned educational intervention.
Asiri, S. A. (2015). Client education plan for improving diabetes management during primary health care in Saudi Arabia. Austin Journal of Nursing & Health Care, 2(2), 1018-1021.
Barrett, S., Lawler, L., & Kyle, A. (2015). Bridging the gap for homebound elderly diabetics: Increasing awareness of interventions for diabetic homebound elderly adults. Journal of Clinical Nutrition & Dietetics, 1(3), 1-3.
Birchenall, J. M., & Streight, E. (2014). Mosby’s textbook for the home care aide (3rd ed.). New York, NY: Elsevier Health Sciences.
Draznin, B. (2016). Managing diabetes and hyperglycemia in the hospital setting: A clinician’s guide (1st ed.). Arlington, VA: American Diabetes Association.
Holt, T. (2015). ABC of diabetes (7th ed.). Hoboken, NJ: Wiley-Blackwell.
Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2014). Health promotion in nursing practice. Upper Saddle River, NJ: Pearson.
Sharma, M., & Romas, J. A. (2012). Theoretical foundations of health education and health promotion. Sudbury, MA: Jones & Bartlett Learning.
Weinger, K., Beverly, E. A., & Smaldone, A. (2015). Diabetes self-care and the older adult. Western Journal of Nursing Research, 36(9), 1272-1298.