Medicine and Health Sciences Commons^™

A Quality Improvement Project To Implement Shared Medical Appointments For The Management Of Type 2 Diabetes In Latino Patients, Denisse Maldonado

Doctor of Nursing Practice (DNP) Projects

Problem: Santa Rosa Community Health (SRCH) is one of the largest federally qualified health centers in Northern California, providing health care to more than 30,000 patients. More than half of the patients receiving care at the SRCH Lombardi site are Latino patients. Patients self-identify as Latino or other ethnicity on the initial health center registration form. SRCH serves 964 patients with diabetes. Due to limited access to appointments and resources, seeing a healthcare provider regularly can be difficult, posing a barrier to diabetes management. Patients with diabetes would greatly benefit from regular appointments with their primary care provider and resource …

Patient-Centered Education To Improve Health Outcomes Of Adult Jamaicans With Diabetes, Patricia Anderson

DNP Qualifying Manuscripts

There is a 42% prevalence of diabetes among Jamaicans (Ministry of Health, Jamaica Health and Lifestyle Survey, 2018). The survey found that Jamaicans will continue to face challenges of diabetes and its complication as approximately four out of ten Jamaicans are unaware that they have diabetes, and thus delay receiving healthcare.

Limited health literacy is predominant among the diabetic Jamaican population and negatively affects health outcomes (Singh & Aiken, 2017). Jamaicans were found to have poor knowledge of diabetes; in particular, they had difficulty identifying clinical signs of hyper/hypoglycemia, the importance of examining eyes and feet for abnormalities, normal fasting …

Understanding Diabetes Health Beliefs And Health Practices In Vietnamese Americans, Linda Sheen

Dissertations & Theses (Open Access)

Background: Diabetes related complications resulting in mortality and morbidity are higher among Vietnamese individuals living in the U.S. with diabetes. Few studies have examined the personal perceptions and cultural beliefs pertaining to disease management. An in-depth understanding of perception and cultural beliefs in regard to diabetes self-management is needed for the development of culturally appropriate interventions in this population.

Purpose: Two specific aims were explored: 1) To explore how Vietnamese individuals living in the U.S. with prediabetes and diabetes conceptualize diabetes self-management and; 2) to understand how Vietnamese individuals living in the U.S. with prediabetes and diabetes integrate …

Quality Improvement Initiative To Increase Comprehensive Eye Exams In Patients With Diabetes, Julia Khoury

Doctor of Nursing Practice

Diabetic retinopathy is the most common microvascular complication associated with poorly controlled diabetes. Yet, only 60% of the diabetic population receives an annual eye examination by an eye specialist. Retinal imaging increases surveillance of retinopathy, however, it does not take the place of a comprehensive eye examination by an ophthalmologist or optometrist. The aim of this quality improvement project was to increase comprehensive eye examinations in patients with diabetes aged 18 to 75 years in a family practice that recently purchased a retinal imager. This quality improvement project occurred over a 10-week period. Project objectives included increasing comprehensive dilated eye …

Increasing The Incidence Of Referrals And Execution Of Diabetic Eye Examinations In A South Texas Primary Care Clinic, Marisa Macias

Doctor of Nursing Practice

Diabetes is a significant public health problem, decreasing quality of life, causing disability and death (CDC, 2017; Foos et al., 2015; Grover & Joshi, 2015). Uncontrolled diabetes can lead to several eye complications including retinopathy and blindness (ADA, 2013; Liu & Swearingen, 2017). As the number of people afflicted with diabetes rises, the need for diabetic eye examination screenings also increases to prevent disability, improve quality of life and prevent blindness (ADA, 2018; Fisher et al., 2016; Garber et al., 2015; Raman et al., 2016).

The purpose of this project was to increase the rate of diabetic eye examination referrals, …

Community Score Card (Csc) On The Quality Of Health Services In Phc Focusing On Patients With Diabetes Mellitus In The Municipality Of Lipjan, Agim N. Krasniqi

UBT International Conference

Community score card was first used in Lipjan Municipality as an instrument for measuring patient satisfaction with health services, and evaluation of PHC services by providers of these services, focusing on type 1 and type 2 diabetes mellitus patients. This activity was developed in support of AQH, through the NGO POLIS and the workers of the PHC-Lipjan The purpose of this research was to identify community needs and opportunities to solve these problems, Involvement of the community in decision-making and monitoring of services in PHC, Relevance of findings by CSC and current internal management and Ministry of Health level.

Methodology …

Diabetes, Bonsitu Hubena

Nursing Student Class Projects (Formerly MSN)

Diabetes is a serious chronic disease that can affect different body systems. There are two categories of diabetes. In Type 1 diabetes, insulin production is diminished or absent due to autoimmune attack on the beta cells in the pancreas. Type 2 diabetes occurs as a result of insulin resistance due to beta cell failure. Although the cause is unknown, some of the contributing factors of diabetes include environmental, genetics, race, and family history. In addition, research has shown a significant linkage between obesity and diabetes. Therefore, it is important to understand the factors that predispose individuals to diabetes as well …

A Quality Improvement Project To Enact Evidence-Based Guidelines To Improve Documentation Of Hemoglobin A1c For Inpatient Diabetes Populations, Karyn C. Kinney

Master's Projects

The purpose of this paper is to describe a quality improvement project aimed to improve the documentation of hemoglobin A1c in the discharge instructions for patients with a diagnosis of diabetes prior to a transition from the acute care setting. Clinical practice guidelines from the American Diabetes Association and patient education recommendations from The Joint Commission are the impetus for this process improvement. The Plan-Do-Study-Act (PDSA) model was utilized to identify, design, and implement the process change in collaboration with an interprofessional team. The documentation rate of hemoglobin A1c was measured on two medical-surgical inpatient hospital units both pre- and …

Effectiveness Of Educational Intervention On Diabetic Knowledge & Hba1c Levels On Kenyan Adults With T2dm, Sabina Jeruto Bett

Doctor of Nursing Practice Projects

Background

Type II diabetes mellitus (T2DM) is a common chronic metabolic disease affecting millions of people globally, which causes many long-term complications such as high blood pressure, chronic kidney disease, improper wound healing and loss of sight. Literature supports that most people, in general and diabetic patients specifically, in Africa, including Kenya are currently not taught about the importance of proper management of their disease. Therefore, many have difficulty following treatment plans, resulting in improper eating, poor glucose control, and diabetic complications. The limited knowledge concerning T2DM contributes to the negative impact this serious disease has on those who live …

Mobile-Based Technology App Used To Improve Self-Care Management Of Patients With Type 2 Diabetes Mellitus, Fred Allen Smith Jr

Doctoral Dissertations and Projects

Billions of dollars are spent on diabetes in healthcare each year. Patients with lower socio-economic-status tend to have poor glycemic control, higher associated diabetic complications, and higher associated mortality rates. In underserved patients with type 2 diabetes, does utilization of a Diabetes app, compared to previous self-care management and clinic education, lower the Hemoglobin A1c over a 3-month period? A 3-month scholarly project was conducted in a small rural town in Virginia with an average median income around $17,000. N=21 were selected for the scholarly project. Inclusive criteria consisted of adults aged 19-70 years with a diagnosis of type 2 …

Type 2 Diabetes (T2d), Janice Loney

Nursing Student Class Projects (Formerly MSN)

ABSTRACT

Type 2 diabetes (T2D) is a devastating disease predisposing individuals to a myriad of serious health complications such as: heart disease, stroke, retinopathy, neuropathy, renal disease, dementia, amputation and early death. Diabetes care has a major economic impact worldwide, as a future family nurse practitioner (FNP) patient education on T2D risk factors, disease process and medical management are vital to halt this growing epidemic. A literature search was conducted and five peer reviewed articles were chosen addressing T2D pathophysiology, risk factors, effects of self-care behaviors and emerging treatment options.

Focused efforts from the literature reviews indicate education and adherence …

Advocate Aurora Apc Grand Rounds Dm Pharm Update 7 2019 Chojnacki.Pptx, Carl Chojnacki

Carl Chojnacki, MBA, MSN, APNP, ANP-BC, AWLS

Functional Exercise Improves Mobility Performance In Older Adults With Type 2 Diabetes: A Randomized Controlled Trial, Kimberlee A. Gretebeck, Caroline S. Blaum, Tisha Moore, Roger Brown, Andrzej Galecki, Debra Strasburg, Shu Chen, Neil B. Alexander

College of Nursing Faculty Research and Publications

Background: Diabetes-related disability occurs in approximately two-thirds of older adults with diabetes and is associated with loss of independence, increased health care resource utilization, and sedentary lifestyle. The objective of this randomized controlled trial was to determine the effect of a center-based functional circuit exercise training intervention followed by a 10-week customized home-based program in improving mobility function in sedentary older adults with diabetes.

Methods: Participants (n = 111; mean age 70.5 [7.1] y; mean body mass index 32.7 [5.9] kg/m²) were randomized to either a moderate-intensity functional circuit training (FCT) plus 10-week home program to …

Fat For Life: The Development Of A Low-Carbohydrate High-Fat Dietary Toolkit For Type 2 Diabetes In Rural Southeast Kansas, Curtis Beall

Doctor of Nursing Practice Scholarly Project

The purpose of this project was to identify the feasibility of a low-carbohydrate high-fat (LCHF) diet in less affluent type 2 diabetics in rural Southeast Kansas, specifically, Crawford County. The author assessed this through the identification of the resources offered in Crawford County, and ultimately, the development of an LCHF dietary toolkit utilizing these resources. The toolkit offers an array of LCHF resources including compliant foods, grocery prices, shopping lists, phone applications, books, internet websites and blogs, accountability forums, and fitness centers. Upon completion of the dietary toolkit a select few healthcare providers directly involved with diabetes in Crawford County …

Long-Term Use Of Metformin And Vitamin B12 Deficiency, Josalyn Joy Grueneich

Nursing Capstones

No abstract provided.

Increasing Physical Activity In Hispanic Adults To Reduce Complications Of Type 2 Diabetes, Linda C. Valenzuela

Doctor of Nursing Practice Projects

Problem Description: Adults in the United States do not exercise sufficiently to meet the specifications outlined in the 2018 Physical Activity Guidelines (U.S. Department of Health and Human Services, 2018). The Office of Disease Prevention and Health Promotion’s (2018) Healthy People 2020 aims to eliminate health disparities and achieve health equity among all population groups in the United States. However, statistics from the U.S. Office of Minority Health (2014) indicate that Hispanics are twice as likely to be diagnosed with type 2 diabetes as non-Hispanic whites. According to a Centers for Disease Control and Prevention (CDC) report in 2015, …

Diabetes Shared Medical Appointment: An Evidence-Based Innovation Project, Mohamed Bojang

DNP Final Reports

The purpose of the evidence-based practice innovation project (EPIP) is to address uncontrolled diabetes by implementing an evidence-based shared medical appointment (SMA) intervention which based on the body of the evidence will help improve diabetes outcomes. A pilot implementation and retrospective chart review were conducted. Data was collected on outcome indicators such as blood pressure, lipid values, body mass index, A1C, and knowledge. The results of a pilot SMA implementation revealed that patients who participated in the weekly SMA saw an improvement in post-mean values compared to pre-mean values. Mean A1c dropped to 7.0% from 7.11%; systolic blood pressure improved …

Complete Care Model Impact On Glycemic Control In California State Prisons, Diane M. O’Laughlin

Doctoral Projects

The Complete Care Model (CCM) is a health care delivery model based on the well-studied and internationally validated chronic care theory. Since the integration of the chronic care theory into California Department of Corrections and Rehabilitation (CDCR) patient care in 2008, steady improvement in health care related mortality has been seen, and there have been no unavoidable health care related deaths in CDCR since 2012 (Gransee, 2018). However glycemic control in CDCR diabetic patients has made no statistically significant change since the implementation of the CCM in 2015 when comparing the two years before and the two years after implementation …

Screening For Social Determinants Of Health In Diabetic Patients Served In Primary Healthcare Centers, Hewan K. Chekol

Doctoral Projects

Background: Social Determinants of Health (SDOH), such as food, transportation, housing, and financial status, plays a significant role in a diabetic patient’s health care outcome. However, primary healthcare centers lack a systematic method of identifying patients with unmet social needs in order to provide appropriate referrals to community resources.

Objective: This project seeks to improve the screening methods of SDOH in a midwestern federally qualified primary healthcare center by incorporating an evidence based SDOH screening tool. This SDOH screening tool is tailored towards diabetic patients.

Method: Kotter’s Eight Step Change model guided the implementation process of this quality improvement project. …

Nutrition And Neurosurgery: Designing A Perioperative Pathway For Elective Spine Fusion Patients, Abigail J. Mckay

Doctoral Projects

Each additional hospital day related to a surgical complication costs an estimated $1,000 (Grusky et al., 2015). Due to the rising costs of healthcare, European professors designed Enhanced Recovery After Surgery pathways to mitigate potential adverse surgical outcomes and associated costs. A primary focus of these pathways emphasizes the importance of pre-procedure nutritional optimization. Literature increasingly supports malnutrition as an independent predictor of postoperative complications and increased length of stay (LOS) (Adogwa et al., 2014). The neurosurgical population has a wide variety of comorbidities that place them at increased risk for nutritional compromise. Thus, a perioperative nutrition pathway was implemented …

The Influence Of Stressful Life Events On The Development Of Type 2 Diabetes, Joshua Minks

Dissertations

This study examined the relationship between distress and the development of Type 2 diabetes mellitus (T2DM) in the presence of established risk factors. Distress secondary to mental health disparities, stressful life events, and work conditions has been shown to promote insulin resistance and the development of T2DM.

Subjects (N=79) diagnosed with T2DM within the previous six months were recruited from SSM Health Centers and VA Medical Centers in the greater St. Louis area. They completed the Recent Life Changes Questionnaire, ENRICHD Social Support Instrument, and a demographic survey and analyses were conducted to determine differences between the veteran …

Cultural And Family Challenges In Type Two Diabetes Self-Care For Puerto Rican Identified Hispanic Adults, Jalil Johnson

Doctoral Dissertations

ABSTRACT CULTURAL CHALLENGES IN TYPE TWO DIABETES SELF-CARE FOR PUERTO RICAN IDENTIFIED HISPANIC ADULTS FEBRUARY 2019 JALIL A. JOHNSON, B.S.N., MIDDLE TENNESSEE STATE UNIVERSITY M.S., UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL, WORCESTER Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Dean Stephen Cavanagh Background: Puerto Rican identified Hispanics are disproportionately affected by type 2 diabetes and co-morbid conditions compared to their white counterparts. Culturally tailored interventions improve self-care for Hispanic populations. Interventions should be tailored to the targeted Hispanic subgroup. The intersection of Familism in Puerto Rican culture as it influences type 2 diabetes self-care is not well understood. Research Aims: The …

An Instructional Module For Nurses To Teach Patients With Gestational Diabetes Mellitus, Josephine Onyekachi Ollawa

Walden Dissertations and Doctoral Studies

Gestational diabetes mellitus (GDM) is a carbohydrate metabolism issue during pregnancy that is dangerous for mother and the baby. GDM occurs in 1 out of 3 diabetic women in 16.2% of live births. GDM knowledge and treatment practices among nurses were found inadequate when nurses’ effectiveness in treating a disease they have a shallow knowledge about (GDM) was investigated in the local medical facility. A GDM instructional module was applied and its effectiveness in promoting nurse’s use of GDM education as a treatment strategy tested. The total concept for knowledge and care, empowerment and the social cognitive theories grounded this …

Implementation Of An Evidence-Based Diabetic Foot Care Protocol And Impact On Health Outcomes, Tina Marie Warfield

Walden Dissertations and Doctoral Studies

Diabetes is a condition that can lead to foot ulcers that often progress to amputation of a limb. Providing patients with education about foot care is crucial because it can help to prevent or minimize the incidence of foot ulcer development and amputation of a limb. Foot care education as a strategy not only empowers patients with proper foot care knowledge and skill to support and motivate self-care but can also enhance the partnership between the provider and patient. The purpose of this quality improvement project was the implementation of a sustainable evidence-based foot care program for adult patients with …

Lived Experience Of Tongans With Obesity And Diabetes, Gladys Adjei-Poku

Walden Dissertations and Doctoral Studies

People of Pacific Island descent are afflicted by obesity and diabetes more than other populations. Although interventions have succeeded in reducing these conditions among other groups, they have been unsuccessful among Tongans and other Pacific Islanders. Furthermore, little is known about the cultural perspectives of this population with a high rate of obesity and diabetes. Accordingly, this descriptive phenomenological study was conducted to investigate the lived experiences of Tongans with obesity and diabetes in a western metropolitan area of the United States to understand their predisposition toward these conditions and suggest appropriate interventions. Purposive sampling was used to recruit 11 …

Strategies For Patient Engagement In A Self-Management Program For Adults With Diabetes, Carolinee Jokotola Ogungbayi

Walden Dissertations and Doctoral Studies

Patients' lack of adherence to diabetes self-management education and support (DSMES) recommendations is a challenge for healthcare. One approach to addressing patient noncompliance with DSMES is through education of staff on current guidelines. In an outpatient facility in South Texas, staff training on current DSMES guidelines was recommended as one of the solutions to the problem of Type 2 diabetes mellitus (T2DM) complications observed among clinic patients. An educational module was created to increase staff knowledge on T2DM and to assist staff members in teaching patients to self-manage T2DM. The module was built on the self-management and health promotion models, …

Educational Plan For Correctional Officers To Increase Awareness Of Diabetes Mellitus Among Inmates, Zaheerah Yasmeen Shareef

Walden Dissertations and Doctoral Studies

In the United States, approximately 30.3 million or 9.4% of the population have been diagnosed with diabetes mellitus. Of these, 8.3 million remain undiagnosed. There are approximately 2 million people incarcerated in detention centers, jails, and prisons across the United States with approximately 80,000 inmates living with diabetes. Correctional officers are not educated to identify and respond to inmates with evolving medical complications, such as low or high blood glucose, which can lead to preventable adverse events, including permanent injury or death. The purpose of this project was to develop an evidence-based education module to teach correctional officers how to …

Improving Provider A1c Testing Frequency Adherence To Recommended Diabetes Guidelines, Susan Ann Simmons

Walden Dissertations and Doctoral Studies

The Appalachian region of the United States has a high prevalence of diabetes, placing residents with diabetes at risk for physical, psychological, social, and financial burdens. To compound the issue, primary care providers often do not adhere to the guidelines established by the American Diabetes Association (ADA) regarding the recommended frequency of testing hemoglobin A1C in patients with diabetes. Lewin's planned change theory guided the project. The purpose of this project was to measure the knowledge of the primary care providers before and after an educational intervention covering the ADA guidelines for A1C monitoring and testing and to assess compliance …

Evaluation Of A Diabetic Point Of Care Education In Primary Care, Mary Cho

DNP Projects

BACKGROUND: Diabetes education is the cornerstone of managing diabetes. The education can be delivered in group or individual sessions. Given that group classes are not always well received, a brief five-minute point of care education was developed and incorporated into patients’ routine diabetic appointment. The effectiveness of the method is yet to be determined.

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) project was to evaluate the effectiveness and acceptability of a recently implemented diabetes point of care education as compared to patients’ usual care in an urban primary care clinic.

METHODS: An outcome evaluation using a retrospective …

An Evaluation Of Depression In Adolescents With Type 1 Diabetes Mellitus, Elleanor Gray

DNP Projects

Depression can significantly affect how adolescents with T1DM self-manage their disease. The combination of depression and diabetes is closely linked to reduction in self-care behaviors, poor treatment adherence, and sub-optimal metabolic control.

PURPOSE: The purpose of this study was to evaluate current screening for depression in adolescents with T1DM and determine the need for additional support or services to improve the quality of routine, follow-up diabetes care.

METHODS: A cross-sectional, retrospective review of electronic medical records was used to evaluate current practice of depression screening for adolescents with T1DM (11-21years) bring followed at a local pediatric diabetes center between April …