Family Practice Nursing Commons^™

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 …

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 …

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 …

Implementing The Hyperlipidemia Statin Use Guideline In Patients With Diabetes Mellitus, Ifeyinwa Eribenne

Doctor of Nursing Practice

Purpose. To implement an evidence-based hyperlipidemia guideline for statin therapy use with diabetic patients. Background. In the United States, cardiovascular disease (CVD) continues to be the leading cause of mortality and morbidity for women and men with diabetes. Dyslipidemia is a modifiable risk factor for CVD and one of the leading drivers behind the development of coronary artery disease. In 2014, the American Diabetes Association issued a new recommendation guideline for using statins as a primary intervention for CVD in patients aged 40–75 with diabetes. Despite advances in prevention and treatment guidelines, the American College of Cardiology and ADA have …

Eye Examination:Satisfying A Quality Care Measure In Diabetes, Meera Shekar

Dissertations

Abstract

Purpose: Diabetic retinopathy (DR), a microvascular complication occurs in patients with poorly controlled diabetes mellitus (DM). A known risk of increased visual impairment associated with DM occurs in patients when the glycosylated hemoglobin level (HbA1c) increases over 7.0%. Therefore, an annual retinal assessment as a quality care measure in diabetes management is necessary. The conducted study aimed to evaluate the documentation of an annual eye exam in all patients with DM in a private family practice clinic and to investigate any possible association between HbA1c level.

Method: This quality improvement study included a retrospective medical record review in …

Culturally Sensitive Diabetic Group Education, Kelly Marie Flores

Doctoral Projects

This study assessed the effectiveness of a culturally sensitive type 2 diabetes group education program delivered to Hispanic women in Merced County. Design: A pre-test post-test design. Purposeful sampling was used. Fifteen Hispanic women from a Merced County outpatient clinic were invited to participate in a culturally relevant group education workshop over a 6-week period. Four (N=4) women accepted the invitation, completed the educational workshop, and participated in the assessments. Topics discussed in the education sessions included: (1) diabetic diet, (2) exercise, (3) blood sugar monitoring, (4) medication, and (5) preventative health. A knowledge check was completed by …

Clustering Diabetes Appointments And Education, April Pugh

Doctoral Dissertations and Scholarly Projects

Diabetes impacts the lives of millions of Americans, and the number is growing rapidly every year. Diabetes education has been demonstrated to have a positive impact of the self-management of this chronic disease and effective in the reduction of A1C, weight, and blood pressure. Barriers to attendance at both diabetes education classes and provider appointments are varied with lack of transportation and available time cited as two of the many reasons, especially in the rural and medically underserved regions of the country. The project assessed a process improvement intervention clustering diabetes education with provider appointments to increase attendance and decrease …

Resilience And Coping In The Adolescent And Young Adult With Type 1 Diabetes, Debra L. Messinger

Seton Hall University Dissertations and Theses (ETDs)

There is a need to understand the roles coping strategies play in enhancing resilience in adolescents and young adults with type 1 diabetes between the ages of 18-30. The purpose of this study was to examine the relationships between and among positive, protective coping strategies (courageous coping), negative coping strategies (defensive coping), and resilience. The Resilience in Illness Model (Haase, Kinter, Monahan, & Robb, 2014) was the theoretical model which guided this research.

A convenience sample was recruited via diabetes organizations’ Facebook and Forum pages, a College Diabetes Network chapter meeting, and Juvenile Diabetes Research Foundations’ (JDRF) sponsored events. Data …

Implementing An Emr Change For The Diabetic Foot Assessment, Nicole O'Neil, Karen Sue Hoyt

Doctor of Nursing Practice Final Manuscripts

The purpose of this project was to implement the American Diabetes Association (ADA) foot assessment guidelines utilizing an electronic medical record (EMR) template. Aims of this evidence based practice (EBP) project were to improve documentation of the comprehensive diabetic foot exam, increase identification of loss of protective sensation (LOPS), and increase podiatry and vascular surgery referrals. Diabetes Mellitus (DM) causes many health complications. The lifetime risk of foot ulceration in diabetic patients is 25%. The goal of Healthy People 2020 is to increase this number by 10% to a total of 21,617,200 individuals. The ADA recommends annual comprehensive foot exam …

Utilizing Culturally Congruent Educational Interventions To Improve Native American Diabetic Outcomes, Laurie Ann Hamilton

Doctoral Projects

Native Americans suffer from diabetes type II at a proportionately higher rate than other populations. Management of diabetes in this population is problematic and compounded by multiple influences such as socioeconomic, cultural and linguistic variables. The purpose of this DNP project was to investigate cultural influences on Native American diabetic outcomes.

Do cultural influences act as barriers to diabetic medication, diet and education understanding? Would a Native American nurse applied education on medication, diet and exercise improve diabetic outcomes in a 3 month period?

A convenience sample of 6 Native American participants obtained at a primary care clinic were given …

The Effect Of Reduced Carbohydrate Diet Education On Hemoglobin A1c In Patients With Type 2 Diabetes, Lauren Parker

Evidence-Based Practice Project Reports

Type 2 diabetes (T2D) is characteristically the result of modifiable risk factors, impacting the health and well being of all ethnic backgrounds across the lifespan. Research has indicated that despite the many risk factors associated with T2D, alterations in dietary macronutrient composition can lead to improvements in disease management and resultant complications. Therefore, the purpose of this evidence-based practice (EBP) project was to provide individuals with reduced carbohydrate (carb) diet education to promote greater glycemic control and reduce associated risk factors through macronutrient modification, specifically carb intake. An integration of the most current evidence obtained from the critically appraised literature …

Exploring The Needs And Preferences For A Diabetes Self-Management Program In Hispanics Living In The Central Valley Of California, Emily Lane Kimble

Doctoral Projects

Diabetes mellitus type 2 is an ever increasing threat to the health of people living in the United States, especially those of Hispanic ethnicity. This ethnic group is disproportionately afflicted with the chronic condition and is also more likely than non-Hispanic whites to suffer from serious complications of diabetes. This project examines this growing problem among Hispanics living in the Central Valley of California by exploring how best to structure diabetes self-management education in a network of community health centers.

The Social Cognitive Theory provides a theoretical basis for investigation into motivation for diabetes self-management. This needs assessment specifically explored …

Compliance With The 2015 American Diabetes Association Screening Guidelines For Diabetes Mellitus Type 2 In Primary Care, Krista L. Johnson

DNP Projects

Purpose: The purpose of this project was to evaluate provider use of hemoglobin (HgA1c) measurement as a method of screening for Type Two Diabetes Mellitus (T2DM) per the 2015 American Diabetes Association screening guidelines in a multidisciplinary primary care clinic in Kentucky.

Methods: A retrospective electronic medical record review was conducted in a large ambulatory care clinic. A master list was compiled of all patients aged 45-89 years who were seen for any reason the first week of November 2015. A total of 127 records that met inclusion criteria were randomly selected. The proportion of patients who were appropriately screened …

Diabetic Prevention The Hard Way: Modified Diet And Increased Exercise, Torrie Reese St.Julien

Doctor of Nursing Practice Final Manuscripts

Background and Purpose: In the United States, 79 million people are pre-diabetic: most have no symptoms. If left untreated, 37% will develop diabetes within 4 years. Fourteen percent of United States health care expenditures are related to diabetic complications. This Evidenced Based Project (EBP) involved a behavioral lifestyle change with the purpose of 7% weight loss and a minimum of 150 minutes of physical activity a week. It was also designed to reduce risk factors and glycated hemoglobin A1c (HgA1c) levels.

Methods: The interventional approach was modeled after the Diabetes Prevention Program (DPP) and Group Lifestyle Balance Program. Participants were …

Transitional Care Of Adult Patients With Diabetes Following Hospitalizations, Eric Tobin

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project was to incorporate a diabetes transitional care program using group visits to improve self-care management behaviors and glycemic control in diabetic patients at a southern California hospital.

Background: Diabetes is a challenging healthcare problem associated with significant mortality and morbidity issues. In 2012, 29.1 million people, or 9.3% of the U.S. population, were diagnosed with diabetes, and 28.9 million of those patients were 20 years of age and older. Today, diabetes is of epidemic proportion worldwide, and a projection of 5.4% of the adult population will have diabetes by 2025. The …

The Effects Of Latent Stage Diabetic Education And Tele-Health Reinforcement On The Knowledge Of Low-Income Diabetic Patients, Hannah M. Chicowlas

Honors College Theses

Diabetes is a chronic disease that affects millions globally. Poverty and obesity are factors that affect the development and progression of this disease. Although education has been identified as a factor affecting treatment adherence, on-going education for diabetes typically occurs in the early stages. This pilot study consisted of a quantitative, comparative study utilizing tele-health as the primary form of educational reinforcement for latent stage, low-income diabetics. Six clients agreed to participate. It focused on participants from a local clinic in Georgia. All participants live at or below 200% of the federal poverty guidelines. An initial survey was followed by …

Implementation Of Food Insecurity Screening In Clinical Setting, Florence Ngozi Soba

Doctor of Nursing Practice (DNP) Projects

This project used the Stetler model of research utilization framework to apply evidence-based findings to clinical settings screening adults with type II diabetes mellitus (T2DM) and low incomes for food insecurity. The project involved the review and critical appraisal of research studies and translation of research-based knowledge into a protocol for the Peach Tree Clinic with respect to the impact of food insecurity on diabetes outcomes in adults with T2DM and low incomes who were at risk of food insecurity. In addition, the proportion of screened at-risk patients who received nutritional counseling was calculated. The proportion of patients with T2DM …

Transitioning Traditional Acute-Episodic Primary Care Visits To Group Visits: An Evidence-Based Approach To Diabetes Care, Bridget Michelle Smith

Doctoral Projects

Diabetes is a national problem that has extended epidemic magnitudes. Its management difficulty impends to overwhelm acute-episodic healthcare systems and challenges the resources of current and future individual primary care providers. According to the Centers for Disease Control and Prevention (CDC) (2012), there are 25.8 million people in the United States or 8.3% of the population who have diabetes. Mississippi ranks second in the nation in the prevalence of diabetes and has the highest percentage of overweight and obese adults in the nation (CDC, 2012). In an effort to bridge the gap with delivery of quality care to patients with …

Promoting Behavior Changes In Patients With Type 2 Diabetes Through Shared Medical Appointments, Shonda Lanette Williams

Doctoral Projects

Diabetes Mellitus (DM) is a chronic disease that affects many individuals in the United States. It was reported that a total of $245 billion is spent annually on both direct and indirect health care costs associated with the treatment of diabetes and diabetic related complications. Diabetes related complications can be prevented or delayed if proper education is done and individuals are willing to practice positive behavior changes and self-manage their disease. The purpose of this doctoral capstone project was to promote behavior changes in patients with diabetes through diabetes self-management education (DSME) in shared medical appointments (SMAs).

This project was …

An Evaluation Of The Effectiveness Of Providing Foot Care Education In A Rural Clinic Setting, Gloria Green-Morris

Doctoral Projects

Diabetes is one of the most frequently diagnosed metabolic disorders and is currently at pandemic magnitude. Approximately 1.4 million adults are diagnosed with diabetes each year. According to the American Diabetes Association (2011), the numbers of diagnoses will more than double by 2030. Because of the high prevalence of diabetes, the perceptions of risk factors and healthy behaviors are important. A good understanding of written and verbal healthcare instructions, healthcare accessibility, and socio-economic status have a direct effect on patient health outcomes and the overall health of the population (Jovic-Vranes, Bjegovic-Marinkovic & Marinkovic, 2009).

Diabetic foot complications are common concerns …