Date Created

9-13-2019

Abstract

This scholarly project was a nonexperimental quality improvement project to create a practice care guideline and algorithm with the intention of enhancing self efficacy in non-compliant chronic disease patients within the primary care setting. The objectives of the clinical guideline and algorithm were to assist primary care providers in identifying low self-efficacy in chronic disease patients, provide guidance in selection of interventions to develop or improve self-efficacy in patients, and promote better disease management. The guideline outlines tools and techniques to give primary care providers the information and skills needed to improve strategies to counsel patients to become more active in the management of their illness, to influence a sense of empowerment, to enhance the ability to face challenges competently, and also in transforming the patient provider relationship into a collaborative partnership Throughout the United States, the level of chronic disease morbidity and mortality is significant. With the burdens chronic disease places on individuals, families, the healthcare system, and society as a whole, this reinforced the need for an increased focus on management at all stages of these diseases. Emphasizing patient responsibility while cultivating an effective patient-provider relationship to enhance chronic disease self management resulted in a promising strategy for managing chronic conditions by iv evolving beyond education to teaching patients to actively identify challenges and solve problems associated with their condition. The overall objective of this project was to provide primary care providers with guidance in the assessment of self-efficacy in chronic disease patients and provide direction toward enhancement in patients’ self-efficacy in order to improve health outcomes. Bandura’s (1994) self-efficacy theory was applied in the practice care guideline and algorithm for providers across primary care settings to utilize to support patients in gaining confidence in decision-making, problem-solving, and self management with regard to their chronic disease as a means to positively impact their health status and quality of life. An integrated literature review regarding chronic disease self-management and self-efficacy was performed; twenty-five articles were selected to guide development of the practice care guideline and algorithm based on scientific and theoretical underpinnings for chronic disease self-management interventions and evidence for their effectiveness. Then while using the best evidence available, a clinical practice guideline and algorithm were developed and designed to enhance self-efficacy in non-compliant chronic disease patients. Practicing nurse practitioners were recruited through email to review the initial version of the clinical guideline and algorithm and then surveyed to elicit opinions and suggestions for improving the clinical guideline and algorithm. Five participants completed the survey. These respondents all identified as females between the ages of 40 through 58. Collectively, there were 52 years of experience among participants and on average, participants reported seeing 44.4 patients per week. Considering whether the proposed clinical guideline and algorithm would be useful and v feasible in the primary care setting, four stated they agreed and one disagreed. Based on the suggestions provided in the survey, changes were made to the practice care guideline and algorithm to enhance benefit and practicality. Considering the results from this non-experimental quality improvement project, it would be pragmatic to offer the opportunity for an expert panel to review the edited practice care guideline and algorithm. The panel could convene in person or within an online format to discuss concerns, suggestions, and future steps. Another questionnaire could be an avenue for pertinent information. Pilot testing the documents in a real-world primary care setting would be a valuable action moving forward in the direction of improved patient care. It would also be beneficial to implement more extensive studies that have the ability to examine self-management scores both pre and post intervention. In summary, while the expert opinion responses of the DNP project were small with five surveys returned, there was indication from participants that the practice care guideline and algorithm could be a valuable tool to utilize in the primary care setting. No current tools, algorithms, or guidelines were reported by expert reviewers to be available or utilized for disease self-management enhancement in non-compliant chronic disease patients. The need for an increased focus on management at all stages of chronic disease is essential. The clinical guideline and algorithm to enhance self-efficacy in noncompliant disease patients could be a positive step toward improved self-management strategies and better health outcomes.

Keywords

chronic disease self-management; self-efficacy and chronic disease; support needs of chronic disease patients; prevention of chronic disease exacerbations

Rights Statement

Copyright is held by the author.

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