Self-management plan of chronic disease among inpatients admitted to a Portuguese Endocrinology unit: a best practice implementation project.

Abstract

Globally, there is an increasing incidence of chronic diseases, particularly, diabetes. Patient engagement in disease self-management is essential to improve outcomes and reduce consumption of health resources. Despite investment in this area, there is a need to improve nursing care practices. To increase compliance of Endocrinology nurses with best practice in promoting self-management of diabetes by patients. The project was conducted in an Endocrinology unit of a Portuguese central hospital. It was based on the JBI's model approach, considering three phases: baseline audit, strategy design and implementation, and follow-up audit. For the audits, 11 criteria were considered. The sample was composed of patients (15 in the baseline; 30 at the follow-up audit), and nurses (15 in both audits). The baseline audit showed that there was poor compliance in some criteria. Four barriers were identified and the strategies/resources to mitigate them. There was improvement in all audit criteria as the project developed (100% compliance in seven criteria; two criteria increased from 0 to 100%). The evidence-based implementation project improved nursing practices for self-management planning of the person with diabetes. The adequacy of the strategies developed should be highlighted, namely the training and reflection on practices. The creation of the standardized discharge procedure has also improved compliance (criteria 7-10). The culture of patient-centred care, the desire to provide quality care, the involvement of the nurse manager, informal leaders, and the support office for information and documentation systems in nursing were facilitators in this process.