A Retrospective Chart Review: Screening Patients With Type 2 Diabetes For Depression, Jennifer Sheldon, Glynnis Haley, Monica Ketchie

The Corinthian

Type 2 Diabetes Mellitus is defined as an impaired production of insulin resulting in elevated blood glucose levels (Brutsaert E., 2020). Globally, approximately 8% to 9% of adults have diabetes mellitus, the majority of which (95%) have Type 2 Diabetes Mellitus, equating to between 624 million to 702 million people (WHO, 2020). Type 2 Diabetes Mellitus represents the seventh leading cause of death, with approximately 1.5 million new cases diagnosed annually in the United States (CDC, 2020).

Depression is clinically defined as a mental health disorder that presents with a continually depressed mood or a loss of interest in daily …

Transition To Home Guideline For Patients With Diabetes, Kathleen R. Burgner

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Diabetes is a leading contributor to preventable hospital readmissions. These hospital readmissions often result from fragmented discharge planning, poor care coordination, and limited post-discharge support. At a 915-bed academic medical center in Southern California, the diabetes-related readmission rate was 13.3%, compared with 11.4% among patients without diabetes. This project aimed to develop an evidence-based Transition-to-Home (TTH) guideline for hospitalized patients with diabetes and evaluate the strength of its recommendations through multidisciplinary stakeholder review.

Methods: An evidence-based guideline development project was conducted over 8 weeks. A comprehensive literature search in CINAHL, MEDLINE, PubMed, and ScienceDirect identified current evidence on transitional …

Evidence-Based Best Practices For Diabetes Education And Self-Care In Appalachia: A Literature Review, Angela J. Occidental, Inga M. Zadvinskis, Jacqueline Hoying

Journal of Appalachian Health

Introduction: The Appalachian Region has a higher prevalence of type 2 diabetes mellitus (T2DM) and associated adverse health outcomes. Although numerous papers report best practices for diabetes care and education, a clinician-friendly, synthesized summary of best practices tailored to Appalachian cultural preferences is lacking.

Purpose: This paper uses the Melnyk & Fineout-Overholt evidence-based framework to identify the best practices for T2DM care and education for Appalachian residents.

Methods: A comprehensive literature search using the databases CINAHL, Academic Search Complete, and PubMed was guided by a PICOT question. Quality appraisals were completed for fifty-two articles; thirty papers were selected to synthesize …

Enhancing Diabetes Care In Adult Patients With Type 2 Diabetes In An Outpatient Setting, Osayanmo Ojo

All Doctor of Nursing Practice (DNP) Scholarly Projects

Type 2 diabetes mellitus (T2DM) is a prevalent chronic condition associated with significant morbidity, particularly among underserved populations. This Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to improve diabetes care among adult patients with poorly controlled T2DM (A1C > 9%) in an outpatient primary care clinic by increasing referrals to the Diabetes Self-Management Education (DSME) program. Guided by the Plan-Do-Study-Act (PDSA) cycle and the OhioHealth Change Management (OHCM) model, the project implemented structured interventions including standardized DSME referral workflows, electronic health record (EHR) prompts, provider education, and culturally tailored communication strategies.

The 12-week initiative targeted 68 eligible patients. …

Implementing The Fib-4 Tool For Liver Fibrosis Screening In Diabetic Patients In Primary Care, Robert I. Montillano

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly non-non-alcoholic fatty liver disease (NAFLD), affects over 1 in 3 adults with type 2 diabetes mellitus (T2DM) and is a leading cause of advanced liver fibrosis. Despite guideline support from the American Diabetes Association (ADA) and American Association for the Study of Liver Diseases (AASLD), screening practices remain inconsistent in primary care. The Fibrosis-4 (FIB-4) index is a validated, low-cost, noninvasive tool for fibrosis risk stratification, yet it remains underutilized despite its availability in many electronic health record (EHR) systems.

Purpose: This Doctor of Nursing Practice (DNP) evidence-based practice (EBP) project …

The Impact Of Motivational Interviewing On African-American Men With Type 2 Diabetes Mellitus, Jamekia Kitchens

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

African-American men with type 2 diabetes face an immense health disparity in the United States, with alarming mortality rates compared to their counterparts. This pilot study examined the impact of motivational interviewing on African-American Men with type 2 diabetes mellitus. The researcher conducted motivational interview sessions using the components of the Diabetes Management Self-Efficacy Scale to guide the meetings. Pre- and post-confidence levels and pre- and post-hemoglobin A1c levels were collected and analyzed. After the completion of three motivational interview sessions, participants displayed significantly higher self-efficacy scores with significantly decreased A1c levels. The results suggest that motivational interviewing has a …

Enhancing Health Literacy Using Video Education And The Teach-Back Method For Hypertension And Diabetes Mellitus Type 2, Shelly-Ann M. Malcolm-Padilla

Doctor of Nursing Practice Projects

Diabetes type 2 and hypertension are chronic illnesses that have both physical and psychological impacts on an individual. Primary care providers play an important role in the management of chronic illness, specifically type 2 diabetes and hypertension. Changing behavior with a commitment to compliance with the treatment plan and living a healthy lifestyle can decrease disease complications for both diabetes and hypertension. With the use of educational videos and the teach-back method to confirm understanding of disease management, the goal of this quality improvement project was to contribute to positive health and lifestyle change for patients, their caregivers, clinical staff, …

Improving Glucose Levels In Adults With Type 2 Diabetes, Kaitlin Castillo

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Type 2 diabetes is a growing health crisis, posing significant challenges not only to individual well-being but also to healthcare systems' financial sustainability. The prevalence of type 2 diabetes continues to rise annually, contributing to increased medical costs, hospitalizations, and long-term complications. Houston, Texas, has a diabetes prevalence of 13.5%, exceeding the national average of 10%. A clinical gap exists in providers’ ability to prevent and manage type 2 diabetes. Prioritizing prevention, early intervention, and improved patient monitoring can reduce incidence rates, lower healthcare costs, and enhance overall population health. A Plan Do Study Act model was utilized for the …

Identify And Overcome The Barriers Of Care From A Patient And Provider Perspective In Adult Patients With Type 2 Diabetes Mellitus In A Federal Qualified Health Clinic: A Quality Improvement Project, Jill Miscovich

Doctor of Nursing Practice (DNP) Manuscripts

Diabetes is a significant healthcare issue that not only effects the United States but also has a global impact, it is costly for the workforce and to manage. Diabetes management is more complex in rural areas due to increased SDOH and barriers to care. The purpose of this quality improvement (QI) project is to identify and overcome the barriers to care from the patients and nurse practitioners’ (NPs) perspectives in adult patients with type 2 diabetes mellitus (T2DM) in a rural federal qualified health clinic (FQHC). A mixed method approach was used including qualitative and quantitative data project manager created …

Identify And Overcome The Barriers To Care From A Patient And Provider Perspective In Adult Patients With T2dm In A Rural Federal Qualified Health Clinic (Fqhc): A Quality Improvement (Qi) Project, Jill Miscovich

Doctor of Nursing Practice (DNP) Manuscripts

Diabetes is a significant healthcare issue that not only effects the United States but also has a global impact, it is costly for the workforce and to manage. Diabetes management is more complex in rural areas due to increased SDOH and barriers to care. The purpose of this quality improvement (QI) project is to identify and overcome the barriers to care from the patients and nurse practitioners’ (NPs) perspectives in adult patients with type 2 diabetes mellitus (T2DM) in a rural federal qualified health clinic (FQHC). A mixed method approach was used including qualitative and quantitative data project manager created …

Diabetic Coaching Program To Improve African American Patients Glycemic Control, Shonda Moore

Student Scholarly Projects

Practice Problem: The purpose of the practice problem was to find out if, among African Americans with type II diabetes who are over 18, adopting a diabetic coaching program that emphasizes diet management can result in better glycemic control over 10 weeks than for those who do not receive coaching.

PICOT: In African Americans with type II diabetes over 18 years of age (P), does a diabetic coaching program on diet management (I), compared to no coaching program (C), improve glycemic control (O) over 10 weeks (T)?

Evidence: The evidence used to guide this project came from databases, including PubMed, …

Evaluation Of Nutritional Guidance From Providers For Patients With Type 2 Diabetes In A Primary Care Setting, Whitney Rice

DNP Projects

Background: Adherence to diet is a challenging part of managing type 2 diabetes mellitus (T2DM). Guidelines recommend including a registered dietician and/or a diabetes educator. While this is the gold standard, there are barriers to implementation in primary care. The Starting the Conversation (STC) diet recall tool can aid primary care providers (PCPs) in providing brief nutrition counseling for patients with T2DM. Purpose: To evaluate the perceptions and practices of PCPs regarding dietary education and documentation for patients with T2DM after provider education and initiation of the STC tool. Methods: This was a quality improvement project using a quasi-experimental pretest …

Diabetes Health Coaching Program In An Eastern Virginia Health Center: A Retrospective Program Evaluation, Moniqueia Flint

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The primary goal of diabetes management is to assist patients in controlling their diabetes and minimizing complications. Diabetic patients require continuous medical care that encompasses medication management, multifactorial risk-reduction strategies, and a multidisciplinary team. Health coaching is an emerging tool used to provide education and motivational techniques to individuals for better self-management of their chronic condition. Health coaching is a proven strategy with favorable effects on hemoglobinA1c (HgbA1c), blood pressure, weight, and health behaviors. A diabetes health coaching program (DHCP) was implemented at an eastern Virginia healthcare center (EVHC). The DHCP’s objective was to assist patients in meeting their individualized …

Improving Effective Care In Obese Patients In A Primary Care Clinic, Amy Miller

Journal of Interprofessional Practice and Collaboration

Background: Obesity is a preventable epidemic and costs the United States $200 billion annually. The leading causes of death are linked to obesity.

Local Problem: In a chart review, 53% of patients at a northeast Louisiana primary care clinic were obese. However, none were offered comprehensive lifestyle intervention. The aim was to increase the percentage of patients with BMI < 30 kg/m2 to 60% over 8 weeks.

Methods: A rapid-cycle quality improvement initiative was implemented using four Plan-Do-Study-Act cycles over 8 weeks. Each cycle produced tests of change related to screening, patient and team engagement, and assessing effective care. Run charts and aggregate tables were used to analyze …

Prevention Of Obesity-Related Morbidity & Mortality In Adults, Rachelle Virgin

Masters Theses/Capstone Projects

Poster presentation on the prevention of obesity related morbidity and mortality in adults.

Barriers To Screening For Diabetic Retinopathy: A Scoping Review, Amy Cooper Rn, Bsn, Lajerica Bates Rn, Bsn, Julie Bridges Rn, Bsn, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

More than 34 million people in the United States have diabetes. Diabetic retinopathy (DR) is a major complication of diabetes and a leading cause of vision loss. Risk factors for diabetic retinopathy include Type 1 and Type 2 Diabetes, hypertension, smoking, and being African American or Hispanic/Latino. This scoping review seeks to analyze the current research on ways to increase vision screenings, thus reducing cases of diabetic retinopathy in adults.

Methods

Between September 2020 and November 2021, a search was conducted using PubMed, EBSCOhost, Medline, and CINAHL to identify articles using keywords such as diabetic retinopathy and ophthalmology. This …

Improving Glycemic Control During The Covid-19 Pandemic: A Quality Improvement Project, Megan Henderson

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Diabetes is a costly, chronic health condition. The COVID-19 pandemic has significantly impacted the delivery of health care and exacerbated chronic health conditions, such as diabetes. Diabetes is one of the most significant comorbid conditions associated with poor COVID-19 outcomes (Cariou et al., 2020). Control of blood glucose levels during the COVID-19 pandemic has proved challenging to maintain. The purpose of this quality improvement project is to identify gaps in diabetic self-care and then implement a diabetic toolkit to improve self-efficacy of diabetes self-management. According to the American Diabetes Association (2022), self-management of diabetes, education, and support from providers is …

Optimizing Diabetes Self-Management Using Continuous Glucose Monitoring And Improving The Transition Of Care For Adult Patients Discharged From The Hospital, Nikki Rose Angeles

Doctor of Nursing Practice

Background: Diabetes mellitus is a chronic medical condition that affects more than 34 million Americans (Centers for Disease Control and Prevention, 2020). The financial impact of diabetes is significant. Americans spend $327 billion on direct medical costs to treat the disease and its associated complications (American Diabetes Association, 2018). The management of diabetes requires a multidisciplinary approach that involves healthcare providers, diabetes self-management support resources, and a high level of commitment from the patient. Patients with diabetes discharged from the hospital often receive fragmented and inconsistent information about managing their health issues. As they transition from hospital to home, their …

Interventions To Improve Adherence To Recommended Diabetic Retinopathy Screening In Adult Patients With Diabetes Mellitus: A Scoping Review, Clare Anderson Bsn, Rn, Dnp, Fnp, Sarah May Bsn, Rn, Dnp, Fnp, Diana Dedmon Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background Diabetic retinopathy (DR) is the leading cause of blindness in adults. Current guidelines recommend that all patients with type 2 diabetes mellitus (T2DM) have a DR screening (DRS) upon diagnosis of T2DM and then annually, but the adherence rate is only approximately 60%. This scoping review aims to evaluate the effectiveness of primary care providers (PCPs) employing strategies to increase compliance with annual DRS among adult patients with T2DM.

Methods Between September 2021 and January 2022, a literature review was performed to collect studies evaluating interventions to increase adherence to DRS. Individual searches of PubMed, SCOPUS, and CINAHL were …

Evaluation Of A Comprehensive Diabetes Mellitus Protocol At A Rural, Federally Qualified Health Center In Southern West Virginia, Hannah D. Davis

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Diabetes mellitus is a chronic disease that affects nearly 34 million Americans. In rural Appalachia, the population is affected disproportionately at a rate of 14% compared to the national average of 10%. Diabetes is a lifelong, chronic condition managed best by a multidisciplinary team-based approach to achieve optimal disease control. Best practices in the care of diabetes support the use of evidenced based care protocols and leveraging technology to decrease the burden of disease. Type 2 diabetes mellitus (T2DM) is the most common type, making it the focal population for evaluation.

Purpose: The purpose of this project was to …

The Physiological Benefits Of A Plant-Based Diet On Cardiovascular Health, Jenevieve Petray

Nursing | Senior Theses

Cardiovascular disease (CVD) is increasingly more prevalent in today’s society and is attributed to an alarming percentage of American hospitalizations and deaths. Americans are unhealthier than ever before, and the main contributor is the Western diet. Diet is a double-edged sword that can offer benefits or detriments to one’s health. CVD encompasses numerous diagnoses originating from various underlying physiological alterations. These alterations are downstream effects of increased body weight and BMI, increased cholesterol levels, decreased insulin sensitivity and increased arterial plaque buildup. Research shows that a plant-based diet has the potential to manage and reverse all fundamental physiological alterations that …

Improving The Early Detection And Management Of Peripheral Artery Disease In Patients With Diabetes Within The Primary Care Setting, Julyssa Amanda Rodriguez

Doctor of Nursing Practice

Background. Diabetes is a significant risk factor for peripheral artery disease. Individuals with diabetes, greater than 50 years of age, having at least one other risk factor should be screened for peripheral artery disease with an ankle brachial index. Purpose. Improve detection and management of peripheral artery disease in persons with diabetes within primary care. Evidence. Individuals with diabetes and peripheral artery disease have an increased risk of adverse cardiac and limb events, impairing the patient’s quality of life and causing long-term disability (Berger & Newman, 2020). Methods. During a 10-week period, these processes were implemented: (a) screening all patients …

The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer

Dissertations

The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel …

Effectiveness Of Ehr-Depression Screening Among Adult Diabetics In An Urban Primary Care Clinic, Filipina C. Schnabel Md, Mph, Msn, Fnp-Bc, Danielle Aldridge Msn, Fnp-C, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR).

Methods We conducted a retrospective chart review on patients …

Patient-Centered Implementation Of Statin Therapy In Patients With Type 2 Diabetes, Giovanna P. Favarato

Doctor of Nursing Practice

Heart disease is the leading cause of morbidity and mortality in Americans with type 2 diabetes mellitus. The American Diabetes Association recommends statins and lifestyle modifications for all patients with type 2 diabetes mellitus for the prevention of atherosclerotic cardiovascular events. A patient-centered approach to primary prevention is encouraged, yet there are no specific instructions regarding implementation. The Statin Choice Decision Aid is a tool designed to facilitate shared decision-making between the patient and the provider in the clinical setting. The 2018 American College of Cardiology/American Heart Association guidelines for the primary prevention of atherosclerotic cardiovascular disease for patients with …

Implementation Of Comprehensive Foot Exams In Primary Care: A Quality Improvement Project, Dora Elia Trevino

Doctor of Nursing Practice

The purpose of this quality improvement project was to increase performance and documentation of provider comprehensive foot exams (CFEs) by 50% among patients with Type 2 diabetes (T2DM) in a small clinic in the southwestern United States.

The project leader assessed clinic systems including the electronic health record (EHR) to identify means to increase CFE completion and documentation rate for patients with T2DM being seen for a chronic disease management (CDM) appointment. A process was created to incorporate a hardcopy CFE documentation form into the EHR and create a pop-up care reminder notification system. Staff and the provider were educated …

An Investigation Of Treatments For The Prevention Of Metabolic Complications For Women Suffering From Polycystic Ovarian Syndrome: Diet, Exercise, Weight Reduction And Herbal Remedies, Brenda Martinez-Puente

Nursing | Senior Theses

The purpose of this research study is to compare the views of traditional versus alternative treatments available to women with Polycystic Ovarian Syndrome (PCOS) suffering from metabolic complications. Alternative treatments include diet, exercise, herbal remedies, or any combination of the three. Pharmacological interventions for the conditions associated with PCOS such as metformin, used to control glucose levels, and clomiphene, used to treat infertility. Through the literature review, articles show herbs and plant products to have similar mechanisms of actions as the pharmacological interventions, but with less side effects. For example, cinnamon was shown to increase insulin sensitivity and pomegranate juice …

The Effect Of Care Coordination On Hemoglobin A1c For Type 2 Diabetes Patients, Lee Ann Hinsky

Electronic Theses and Dissertations

The purpose of the study was to test the impact of care coordinator visits by primary care registered nurses on serum hemoglobin A1c (HbA1c) levels in patients with type 2 diabetes. In the study, the researcher compared 2 groups of type 2 diabetes patients—those who had care coordinator visits from registered nurses and those who did not—through retrospective data collection and analysis from the patients’ electronic medical record from July 2018 through December 2018. An independent samples t test was used to compare the means of the intervention and control groups’ change in HbA1c levels. The intervention and control groups …

Using The Adam Questionnaire In Primary Care To Identify Hypoandrogenism In Males Aged 40 Years Or Older, Jeremy Burns

Doctor of Nursing Practice

Testosterone replacement therapy (TRT) has been shown to improve the symptoms of metabolic syndrome by reducing Hemoglobin A1C, belly fat, cholesterol, and blood pressure (Cunningham, 2015). The ultimate goal for testosterone-deficient patients is to have an improved quality of life by starting TRT. This quality improvement project was conducted at a small primary care clinic in South Texas. The project was started by screening 84 male patients ≥ 40 years of age using the Androgen Deficiency in Aging Males (ADAM) questionnaire. The ADAM questionnaire was considered positive for anyone who answered “yes” to 3 or more questions or “yes” to …

Evidence-Based Foot Care For Persons With Type 2 Diabetes, Nicole Gutierrez

Doctor of Nursing Practice

Unmanaged Type 2 diabetes leads to macrovascular changes that affect the lower extremities, thereby damaging the sensory nerve fibers and leading to diabetic peripheral neuropathy. These patients may not be able to feel pain, heat, or cold in their lower extremities and often describe feelings of numbness and tingling. This sensory deficit may lead to the development of diabetic foot ulcers which often result in amputation. These preventable foot complications may be identified promptly with adequate diabetic foot exams. Comprehensive diabetic foot examinations reduce the occurrences of foot complications associated with uncontrolled glucose management and improves health outcomes for patients …