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Diabetes mellitus (DM) is a long lasting chronic metabolic disorder characterized by elevated blood sugar,  including increased blood pressure, body fat around the waist and cholesterol level. As per  the International Diabetes Federation (IDF), around between the ages of 20 to 79 years, 415 million adults had DM  in 2015. DM is a major issue  worldwide,  and they estimate this number  to go up  to another 200 million by 2040. To avoid this problem, all patients with diabetes need to educate how to check blood sugar at home to avoid the DM complications. DM and lifestyle change, including  physical exercise and diabetes diet which is low fat, low calories and naturally rich in nutrients. Self-checking blood sugar at home is important for them. Regular screening for A1C and cholesterol levels is necessary in diabetes patients (Goyal,  & Jialal2018).
Involving family and caregivers in diabetes management is important because family makes a big impact on DM patients to help in deciding to follow recommendations for medical treatment, and ability to start and maintain changes in physical activity, diet and exercise. 
What are the common barriers to evidence translation in addressing this problem?
The most frequent barriers to implementation of EBP lack of resources includes, Lack of internet service at work to use, medical and nursing libraries, medical database and nursing eBooks, UpToDate  to find the information for evidence-based practice. 
Lack of time, shortage of nurses, management fail to provide support to nurses to use EBP, lack of leadership direction and  organizational support for EBP.
Lack of equipment and  in-service training  
Lack  of continued education for evidence based practice and  also lack of  teaching strategies (White et al.,2016).
What strategies might you adopt to be aware of new evidence?
Encourage  unit staff and  management leaders to take part in the EBP committee for updates including the chief nurse executive (CNE), to create an environment to implement evidence based practice. Choose  the  model for assuring  that the EBP team has  appropriate knowledge and skills considering a change in to  practice ( Dang and Dearholt,2018).
Use good teaching strategies for EBP knowledge and skills including, free internet access at work,  interactive lectures, clinical practicum projects, small group work, journal clubs for nurses, reading quizzes question free for nurses, clinical nurse PowerPoint presentations, post-clinical conferences and  workshops for free of cost for nurses. 
At work create a learning environment. Keep teaching strategies simple so staff can enjoy learning and make EBP a natural part of the academic culture. Increase awareness and understanding in new graduate nurses for EBP to stay updated for new protocol. Study shows oral presentations of students’ research found in a hospital and outpatient setting  as an important part of the teaching and learning method (Horntvedt,2018).
How will you determine which evidence to implement?
Step 1: Ask clinical questions using the  PICOT formula.  Identification of a clinical issue or practice in question using the model. 
P – Patient problems, 
I – Intervention, medication, education, treatment and diagnostic tests).
C – compared to other treatment
O – Outcome, consequence
Step 2: Searching for the best evidence to use in the practice to  make effective and justifiable decisions. Evidence should have been obtained from credible research sources and peer-reviewed ranked based on strength using a standardized obtained from scientific research
Step 3: Critically appraising the evidence, and proven by scientific methods evidence for delivering safe, effective, patient centered health care to a specific population. 
Step 4: Addressing the enough to meet the need  evidence: to apply or not to apply 
Step 5:  Evaluate the outcomes of the decision  of evidence (White et al.,2016).
How will you ensure continuation or sustainability of the change?
Methods to help sustain improvement include, assess ability,  process  performance boards to check to visually track staff, setting standard work, and daily huddle improvement. Process control and performance boards are changing the way of institution Strategies  to communicate improvement results to  employees  and management. To attain sustainable change, organizations  will start new ways of working rather than adding something on to routine work including training for new staff , review the staff monthly performance, focusing on the small things rather than major issues, daily huddles to discuss the problem and improvements. Daily 15 minutes huddles not only solve the frontline staff problems on a daily basis also helps to  engage  unit staff members and a culture of improvement (Silver etal.,2016).
References 
Goyal, R., & Jialal, I. (2018). Diabetes Mellitus Type 2.https://www.ncbi.nlm.nih.gov/books/NBK513253/ (Links to an external site.)
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2016). Translation of evidence into nursing and health care (2nd ed.). Springer Publishing Company.
Dang and Dearholt (2018) . Chapter 9: Creating a Supportive EBP Environment. https://sigma.nursingrepository.org/bitstream/handle/10755/623549/FreeDownload_JohnsHopkinsEBPModelGuidelines3rdEdition_DangDearholt.pdf;jsessionid=6B3D94356C96B32DAC91ABD3182FB352?sequence=1 (Links to an external site.)
Horntvedt, M. E. T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: a thematic literature review. BMC medical education, 18(1), 1-11.
Silver, S. A., McQuillan, R., Harel, Z., Weizman, A. V., Thomas, A., Nesrallah, G., … & Chertow, G. M. (2016). How to sustain change and support continuous quality improvement. Clinical Journal of the American Society of Nephrology, 11(5), 916-924.
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