Description
Dissemination of EBP and research, such as presenting results at a conference or writing an article for a journal, is an important part of professional practice. Identify one professional journal and one nursing or health care conference where you might present your project. Discuss why each of your choices is the best option for you to disseminate your new knowledge.
Running head: CAPSTONE PROJECT CHANGE PROPOSAL
Capstone Project Change Proposal
Gregory Catania RN
Grand Canyon University
NRS 490
1/20/19
CAPSTONE PROJECT CHANGE PROPOSAL
2
Shared Medical Appointments with Registered Nurse for Better AIC Control in Diabetes
Background
Diabetes described as a complex, chronic illness that requires tight glycemic control to
prevent risk factors associated with Diabetes. There is evidence of tighter glycemic control
helping reduce risks associated with diabetes like vascular damage and organs failure. The
chronic hyperglycemia associated with long-term damage, dysfunctional organs and potential
organs failure. Uncontrolled diabetes affects the eyes, kidneys, the heart, nerves, and blood
vessels (American Diabetes Association, 2014: S83).
The growing incidences of diabetes without a comparable level of care and glycemic
control exposes individuals to the risk factors associated with diabetes. However, research on
lifestyle interventions has demonstrated delayed onset of diabetes-related risks with people with
impaired glucose tolerance (Chen, 2018: 13). This paper aims to validate the effect of consistent
medical intervention exploring the mediating role of the registered nurse. The PICOT study
shades light using empirical evidence.
Problem Statement of PICOT Study
Diabetes has persistent being a health concern globally despite improvement in treatment
and growing knowledge in its management. The prevalence of non – communicable diseases is
on the rise with 19 million mortality associated with cardiovascular diseases; diabetes is
remaining a significant contributor (Vakili et al., 2015). Globally 1.7 billion people are
overweight with a substantial 315 million being obese. The population with type 2 diabetes
estimated at 250 million people and the number is projected to increase to 400 million by 2025
according to Marseglia et al. (2016).
CAPSTONE PROJECT CHANGE PROPOSAL
3
PICOT Question:
1. An increased glucose level is independently related to an increased A1C level. Does reducing
the A1C levels with specialized teaching from the nurse, practitioners, and dieticians help to
control diabetes on adult patients?
2. Do shared medical appointments improve glycemic control through Registered Nurse
Mediation?
Population:
The populations for the study are American adult patients diagnosed for type 2 diabetes,
aging 40 to 60 years old. This population is heterogeneous concerning co-morbidities and
general health status, which is essential to establishing the appropriate intervention.
Intervention:
The proposed intervention involves active Registered Nurses involvement in assisting
patients with type 2 Diabetes keep appointments, observe strict adherence to medications, dietary
and other recommendations. The nurse would help monitor record keeping with regard to fasting
blood sugars, time of taking medication in the 12 weeks during the study. The study will note the
essential parameters like blood sugar, weight, and other vital measurements at the beginning of
the study and the end of the study.
Comparison:
To determine whether the intervention is successful; A1C levels would be measured
before and after the changes in lifestyle and diet.
Outcome:
At the end of the study, it is expected that the A1C levels of adult diabetic patients that
adhere to study recommendations would reduce.
CAPSTONE PROJECT CHANGE PROPOSAL
4
Timeframe:
The research proposed to take 12 weeks.
PICOT Purpose Statement
Control of type 2 diabetes for American newly diagnosed adult patients has been
problematic (P) due to the poor lifestyle and diet, which leads to an increased glucose level.
Specialized teaching from the nurse, practitioners, and dieticians is an effective strategy to make
the patients live appropriately by eating the right food and doing exercises (I), which can enable
them to control their A1C levels (C) and live the normal life (O) within 12 weeks (T).
Education as regards to lifestyle modifications has been proved to be an effective
intervention for controlling type 2 diabetes. Kuo et al. (2015) indicate that lifestyle interventions
such as regular exercises and diet changes reduce the incidence of diabetes by 53 percent
compared to the control group. People assigned to these interventions reported reduced A1C
levels than the control group. In a similar study by Islam et al. (2014), changing the lifestyle
plays a crucial role in reducing the glucose levels, which further minimizes the cases of diabetes
by 27 percent.
Hence, there is an essential relationship between increased glucose level and increased
A1C level as well as the lifestyle change and reduced A1C levels, which leads to effective
control of diabetes. Among patients with pre-diabetes, it is worth to control their diet and do
regular exercises to help in a decrease of diabetes occurrence. Failure to prevent diabetes means
increased mortality. It is, therefore, the responsibility of each person to ensure they are living a
healthy life to lower the risk of diabetes.
CAPSTONE PROJECT CHANGE PROPOSAL
5
Literature Review
There is evidence of the efficacy of oral anti-glycemic agents in controlling diabetes. In
the PICOT statement, do socioeconomic factors, biochemical characteristics and oral
medications relate to the complications of diabetes? This question aims at investigating the
clinical features of patients with type 2diabetes on oral drugs and determines the complications
and risk factors in the patients. (Islam, 2014:7). Does uncontrolled diabetes affect cognitive
function-a predisposition to dementia? This other research question aims at finding out the effect
of uncontrolled diabetes on the risk of dementia. (Marseglia, 2016:1072)
Is there a difference in cost between Nursing practitioners and primary care physicians?
This research question aims at investigating if there is a difference in cost and level of care
between Nursing practitioners and primary care physicians. It also consists of an explored eye
examination, cholesterol, HbA1C, neuropathy, referrals, and costs between Nursing practitioners
and Primary physicians (Kuo, 2015:1982). Does medication adherence have any effect on
glycemic control among diabetic patients? This research question aims at looking at the
quantitative study of medication in relevance to diabetic patients. (Almadhoun, 2018:3).
The research questions relate closely with the aim of finding out more information and
statistics about diabetes and the precautions that can be taken to prevent its development. My
capstone project research question; does diabetes nursing visits and improving A1C levels to the
required status over 12 weeks help control diabetes? This question aims at finding out if regular
visits of the patients by nursing practitioners and improving their A1C levels will help control
diabetes.
CAPSTONE PROJECT CHANGE PROPOSAL
6
Theory of Planned Behavior
The PICOT study is grounded in the theory of planned behavior advanced by Ajzen
(1991). The approach has been used in many fields to explain behavior and intentions. The
approach is relevant in the current study because there are aspects of patients desiring health that
can be achieved through lifestyle modification, adhering to medication treatment protocols and
exercising. The motivation to modifying lifestyle is triggered to avert risks associated with
uncontrolled diabetes.
Implementation plan
The study will recruit 20 types 2 diabetic patients with uncontrolled diabetes, ten male
and ten female between the ages of 40-60 years. The respondents’ vital data will be collected at
the beginning of the intervention and monitored over twelve weeks and at the end of the study.
The data will then be analyzed to determine the effect of registered nurses in facilitating
adherence to treatment and lifestyle modifications by the study respondents as suggested by
physicians, dieticians, and pharmacists. The intervention plan is a multi-dimensional and holistic
to determine the mediating role of the registered nurse influence in diabetes control.
Potential Barriers to the Intervention
There are inherent limitations to the PICOT study; first, the respondents may drop-off
during follow-up thus affecting the survey. Secondly, the study sample size may be too small to
allow generalization. Thirdly, there is the possibility of data interference reducing reliability and
validity of the study. Lastly, the follow-up period may be too short to experience a remarkable
change in outcome. The limitations were overcome by the nurse taking leadership in
communicating and creating professional relationships with the respondents. Calls were made in
CAPSTONE PROJECT CHANGE PROPOSAL
7
advance to confirm clinic days, reminder respondents to take medication and adhere to the study
protocol.
Conclusion
In conclusion, as evident in the article, there have been various research projects that
offer factual support to the PICOT study. Research projects are relatable in a way that they aim
at finding out the best applicable methods of controlling diabetes and AIC levels.
There are reports and research findings that contribute to providing more information on
the control and management of diabetes. These include; Effect of Uncontrolled Hyperglycemia
on levels of Adhesion Molecules in Patient with Diabetic Mellitus Type 2 and the effects of
health mentoring program in community-dwelling vulnerable elderly individuals with diabetes.
The proposed PICOT study will illuminate the possible mediating role of the Registered Nurse in
improving the treatment and management of type 2 Diabetes. The results from the PICOT study
demonstrate that the part of the nurse is vital is achieving tighter glycemic control. All cases
except one recorded a real reduction in AIC.
CAPSTONE PROJECT CHANGE PROPOSAL
8
References
Almadhoun, M.R (2018) Journal of Clinical and Experimental pharmacology 8 (3), pp.1-10
American
Diabetes
Association.
(2014).
Diagnosis
and
classification
of
diabetes
mellitus. Diabetes Care, 37(Supplement 1), S81-S90. DOI:10.4172/2161-1459.1000250
Gong, Q., Zhang, P., Wang, J., Ma, J., An, Y., Chen, Y. & Chen, Y. (2018). Reducing Morbidity
and Mortality in Type 2 Diabetes by Lifestyle Intervention: 30-Year Follow-Up of the Da
Qing Diabetes Prevention Study.
http://dx.doi.org/10.3233/JAD-160266
Islam, S.M.S., Alam, D.S., & Wahiduzzaman, M., Nielsen, L.W, Fresch, G., Ferrari, U, Seisoler,
J, Rouf, H, M.A & Lechner, A. (2014). Clinical Characteristics and Complications of
Patients with Type 2 Diabetes Attending an Urban Hospital in Bangladesh. Diabetes and
Metabolic
Syndrome:
Clinical
Research
Reviews,
1-7
http://dx.doi.org/10.1016/j.dsx.2014.09.014
Kuo, Y., Goodwin, J.S. & Chen, N. Lwin, K.K., Baillargeon, J., & Raji, M.A. (2015). Diabetes
Mellitus Care Providers by Nurse Practitioners versus Primary Care Physicians, Journal
of American Geriatric Society. 63 (10), 1980-1988
Marseglia, A., Fratigioni, L., Laukka, E.J., Santoni, G., Pedersen, J., Backman, L. & Xu, W.
(2016). Early Cognitive Deficits in Type 2 Diabetes A Population-Based Study. Journal
of Alzheimer Disease. 53, 1069-1078
Ruszkowska-Giastek, B., Sollup, A., Wernik, T., Rupiecht, Z., Golalczkyk, K., Gadomska, G. &
Rosc, D. (2015). Effect of Uncontrolled Hyperglycemia on levels of Adhesion Molecules
in Patient with Diabetic Mellitus Type 2. Zhejiang University- Science (Biomedical and
Biotechnology) 16 (5), 355-361
CAPSTONE PROJECT CHANGE PROPOSAL
Vakili, S.T.T., Nezami, B.G., Shetty, A., Chetty, V.K. & Srinivasan, S. (2015). Association of
High Dietary Saturated Fat Intake and Uncontrolled Diabetes with Constipation:
Evidence from the National Health and Nutrition Examination Survey. Neurogastoral
Motil, 27 (10), 1389-1397
Wol, S.K. (2018) Journal of Korean Academy of Nursing 48 92) 182-194
9
CAPSTONE PROJECT CHANGE PROPOSAL
10
Appendix
Literature Evaluation Table
Student Name: Gregory Catania RN
Change Topic (2-3 sentences): Better Diabetic A1C control in outpatient adult clinic with
specialized nursing visits that include education, lifestyle changes, medications and diet.
Criteria
Author, Journal
(Peer-Reviewed),
and
Permalink or
Working Link to
Access Article
Article 1
Islam, S.M.S. et al.
Journal of Diabetes &
Metabolic Syndrome,
Clinical Research & Reviews
http://dx.doi.org/10.1016/j.ds
x.2014.09.014
Article 2
Article 3
Article 4
Marseglia, A. et al.
Journal of
Alzheimer’s
Disease Vol. 53,
p.1069-1078
http://dx.doi.org/10
.3233/JAD-160266
Kuo, Y. et al.
Almadhoun, M.R
et al.
Journal of
Clinical and
Experimental
pharmacology 8
(3), p.1-10
Journal of American
Geriatric Society
(10), 1980-1988
https://doi.org/10.111
1/jgs.13662
DOI:10.4172/21611459.1000250
Article Title and
Year Published
Clinical Characteristics and
Complications of Patients
with Type 2 Diabetes
Attending an Urban Hospital
in Bangladesh
(2014)
Early Cognitive
Deficits in Type 2
Diabetes A
Population Based
Study
(2016)
Diabetes Mellitus
Care Providers by
Nurse Practitioners
versus Primary Care
Physicians
(2015)
Research
Questions
(Qualitative)/Hypo
thesis
(Quantitative), and
Purposes/Aim of
Study
To find out the relationship
of social economic factors in
T2D with complications of
diabetes
To explore biochemical
characteristics in T2D and
diabetic related
complications
To find out diabetic related
complications among Pt
taking oral medications and
development of
complications
To find out if
uncontrolled
diabetes has an
effect on cognitive
function- a
predisposition to
dementia
To explore
differences in cost of
care between Nursing
practitioners
compared with
primary care
physicians
Study explored eye
examination,
cholesterol, HbA1C,
neuropathy, referrals
and costs between NP
and Primary
physicians.
The study aim: to
investigate if there is
a difference in cost
Study aim: To investigate
the clinical features of
patients with type 2 diabetes,
Purpose of the
study is to find out
if diabetes
contributes to risk
of dementia (196)
Study Aim: To
Assessment of
Medication
Adherence and
its association
with glycemic
control among
type 2 diabetes
mellitus patient
in Gaza
(2018)
To find out if
medication
adherence has
any effect on
glycemic control
among T2D
patients
Quantitative
study
CAPSTONE PROJECT CHANGE PROPOSAL
11
on oral medication and
determine the complications
and risk factors in the
patients (515).
find out the effect
of uncontrolled
diabetes on the risk
of dementia
Design (Type of
Quantitative, or
Type of
Qualitative)
Setting/Sample
Study was a cross-sectional
quantitative inquiry
The study was a
cross-sectional
quantitative study
Sample size 515 patient at
outpatient setting.
Sample size was
196 in a home for
the elderly in
Sweden
Methods:
Intervention/Instru
ments
Mixed method data collected
through questionnaire, face to
face interview, laboratory
investigations ECG, eGFR,
Blood pressure machine,
observation during outpatient
visit
The collected data was
analyzed using descriptive
statistics, and inferential
statistics. The analysis
deployed used t-test, logic
analysis and simple logic
regression analysis
Methods included
observation,
laboratory tests,
cognitive functions
tests
Analysis was done
using multivariate
linear regression to
estimate
differences and
multi-nominal
logistic regression
to examine
association
Statistical Logistic
regression model
The study revealed that even
in the best clinical setting the
control of diabetes was
suboptimal. Average HBA1C
was 8.3; hypertension 51%,
71% had uncontrolled T2D.
Uncontrolled diabetes led to
eye complications (68.9%),
chronic kidney disease
(21.3%), CVD (11.8%) and
Neurological issues (2.5)
from the study subjects.
There is need to have
consistent screening using
HBA1C goal, reduce BP and
addition of statins to
treatment regimens to help
The study reported
that uncontrolled
diabetes exposes
patient to risk of
dementia.
There was no
significant difference
the two groups
regarding costs
except Nursing
practitioners rarely
performed eye
examinations, there is
risk of Nursing
practitioners Rx
wrong medications
Control is diabetes
is essential in
reducing risks
associated with
diabetic
There is need to have
a treatment protocol
that investigates eyes,
HbAIC, CVD,
Neurological
Analysis
Key Findings
Recommendations
and level of care
between Nursing
practitioners and
primary care
physicians
Retrospective cohort
study
Evaluating data
provided by
Medicaid from
beneficiary of
primary care
N=64,354
The data collected
was coded and
analyzed with regard
to study variables
Cross-sectional
study
T2D in Gaza
attending
diabetic clinic
Sample size 148
Patients were
followed through
face to face
questionnaire,
laboratory
examination to
monitor progress
Descriptive
statistics and
inferential
statistics done.
Regression
analysis to
determine
influence of
independent
variables
The study found
out that majority
of the patients
did not comply
with treatment
instruction
leading to 56.1%
having poor
control.
Need to improve
medical
adherence to
improve T2D
glycemic control
CAPSTONE PROJECT CHANGE PROPOSAL
lower high cholesterol.
Explanation of
How the Article
Supports
EBP/Capstone
Project
The article recommends
control of blood sugar as a
means of reducing diabetic
complications. PICOT study
seeks to enhance the use of
HBA1C as measure of
controlling T2D through
education, screening and
patient management in diet &
lifestyle change because
drugs alone are insufficient.
Criteria
Author, Journal
(Peer-Reviewed),
and
Permalink or
Working Link to
Access Article
Article 5
Ruszkowska-Giastek,
B. et al.
Zhejiang
University- Science
(Biomedical and
Biotechnology)
12
complication.
Diabetic control
will delay
cognitive problems
in patient T2D
Controlling
diabetes help delay
cognitive function
impairment, nurses
can help patients
gain proper control
through education,
diet, exercise and
medication
Article 6
Vakili, S.T.T. et al.
Neurogastoral
Motil, 27 (10),
1389-1397
https://dx.doi.org/10.
1111%2Fnmo.12630
complications to
improve primary care
Nurses have a
significant role in
helping patient with
T2D manage tighter
glycemic control.
Nurses can help
patient and doctors
achieve targeted
HbAIC < 6.4
The article is
important
because
adherence to
drugs leads to
better glycemic
control
Article 7
Article 8
Wol, S.K. et al.
Journal of Korean
Academy of Nursing
48 92) 182-194
https://doi.org/10.40
40/jkan.2018.48.2.1
82
Kostev, K. et al.
Journal of
Diabetes, science
and technology
https://doi.org/10.
1177/1932296817
710477
Prescription
Patterns in
Disease control in
T2D Mellitus in
Nursing home and
Home care setting:
Retrospective
Analysis in
Germany
(2018)
To determine the
influence of
treatment setting
on diabetes
control
https://link.springer.co
m/content/pdf/10.1631
%2Fjzus.B1400218.pdf
Article Title and
Year Published
Effect of Uncontrolled
Hyperglycemia on
levels of Adhesion
Molecules in Patient
with Diabetic Mellitus
Type 2
(2015)
Association of High
Dietary Saturated Fat
Intake and
Uncontrolled
Diabetes with
Constipation:
Evidence from the
National Health and
Nutrition (2015).
The effects of health
mentoring program
in community
dwelling vulnerable
elderly individuals
with diabetes
(2018)
Research
Questions
(Qualitative)/Hyp
othesis
(Quantitative),
and Purposes/Aim
of Study
To evaluate the
concentration of soluble
forms of vascular
adhesion in patient with
controlled and
uncontrolled diabetes
type 2
Cross-sectional
Quantitative study
Hypothesis there is
no relationship
between diabetes and
constipation.
To determine the
influence of
mentoring in the
community on
health treatment
outcome in T2D
CAPSTONE PROJECT CHANGE PROPOSAL
Cross –sectional
study, randomized,
control, quantitative
design
Korea setup with
elderly at risk of
dementia, diabetes
complications 96 at
the start and 70 at
study end.
Follow up,
laboratory analysis
Quantitative
longitudinal
comparative study
Descriptive
Statistical and
inferential statistics
analysis
Statistical analysis
using Wilcoxon
tests and Chi
squared test to
compare analyze
results
There is a significant
relationship between
diabetic patients and
constipation
compared to no
diabetic subjects
Mentoring is an
effective strategy in
monitoring the
diabetic patients in
the community
There was no
significant
different between
the two groups.
The mean age at
the nursing homes
80.7 years and
those at home 74.8
years.
Patients in any set
up provided
adequate
education is
offered treatment
goals will be
achieved.
The article is vital
because nurses
attend to patient’s
outpatient and
inpatient nurses
facilitate glycemic
control.
Design (Type of
Quantitative, or
Type of
Qualitative)
Setting/Sample
The Study was a
quantitative controlled
randomized inquiry
Examination Survey
Poland sample size 62
with 35 diabetic, 27
diabetic uncontrolled
and 25 healthy subjects
Diabetic patients
non- Hispanic 6207
subjects
Methods:
Intervention/Instr
uments
Laboratory analysis,
urine, blood and kidney
function tests
Analysis
Statistical analysis
involved test for
normality, ANOVA for
variance and Pearson
correlation analysis to
test relationship among
variables
Control of diabetes
delays vascular
impairment
Physical and
laboratory
examination, BMI,
diet water intake
Descriptive Statistics
and inferential
statistical analysis
was deployed
Key Findings
13
Recommendations
Doctors need to ensure
tight control of diabetes
to prevent vascular
complications and
neuropathy
Diet is instrumental
in managing diabetes
and ensuring HbAIC
targets are reached
for tighter glucose
control.
Mentoring need to
be incorporated in
management of
T2D in the
community
Explanation of
How the Article
Supports
EBP/Capstone
Control of Diabetes
delays diabetic related
complication including
vascular impairment,
CVD and heart disease
The article is
important because
diabetic control can
help reduce
constipation in T2D
pts
The nurses are
important as
treatment facilitators
in the community
with regard to
education
Germany
comparing T2D in
nursing homes and
at home 9850
subjects /2
Analyzed, stored
data between 2011
and 2015
CAPSTONE PROJECT CHANGE PROPOSAL
14
Table of Respondents Data
No
Respondents Name
Gender
Age
1
Ann P
F
42
2
Peter T
M
3
Jane H
4
HBAIC start
HBAIC end
Remarks
30.5
7.2
6.5
Positive
56
28.5
8.3
7.8
Positive
F
57
25.8
6.9
6.3
positive
Grace O
F
43
30
9.1
7.7
Positive
5
Hilary C
F
45
29
7.7
7.7
Neutral
6
Barrack K
M
40
32.5
9.2
7.2
Positive
7
Giuliani M
M
59
28
6.9
6.2
Positive
8
Yuri J
M
60
27
7.9
6.5
Positive
9
Doris M
F
40
26
6.6
6.0
Positive
10
Fleur H
F
41
30
7.0
6.1
Positive
11
Timothy G
M
55
19
6.7
6.2
Positive
12
George H
M
46
24
7.5
6.9
Positive
13
Hannah Y
F
48
31
8.2
7.1
Positive
14
Jacobs M
M
49
27
7.8
6.9
Positive
15
Shah T
F
58
30
9.5
8.2
Positive
16
Georgas H
M
52
29.9
8.9
7.2
Positive
17
Petrobras G
M
47
28
7.3
6.3
Positive
18
Eve T
F
57
27
6.9
5.9
Positive
19
Harish P
M
53
29.5
8.8
6.4
Positive
20
Shah M
F
45
30
7.8
6.1
Positive
Table: Capstone Change Variables
BMI
CAPSTONE PROJECT CHANGE PROPOSAL
Key
BMI 30
Obese
15
Purchase answer to see full
attachment
Capstone Project Change Proposal
Gregory Catania RN
Grand Canyon University
NRS 490
1/20/19
CAPSTONE PROJECT CHANGE PROPOSAL
2
Shared Medical Appointments with Registered Nurse for Better AIC Control in Diabetes
Background
Diabetes described as a complex, chronic illness that requires tight glycemic control to
prevent risk factors associated with Diabetes. There is evidence of tighter glycemic control
helping reduce risks associated with diabetes like vascular damage and organs failure. The
chronic hyperglycemia associated with long-term damage, dysfunctional organs and potential
organs failure. Uncontrolled diabetes affects the eyes, kidneys, the heart, nerves, and blood
vessels (American Diabetes Association, 2014: S83).
The growing incidences of diabetes without a comparable level of care and glycemic
control exposes individuals to the risk factors associated with diabetes. However, research on
lifestyle interventions has demonstrated delayed onset of diabetes-related risks with people with
impaired glucose tolerance (Chen, 2018: 13). This paper aims to validate the effect of consistent
medical intervention exploring the mediating role of the registered nurse. The PICOT study
shades light using empirical evidence.
Problem Statement of PICOT Study
Diabetes has persistent being a health concern globally despite improvement in treatment
and growing knowledge in its management. The prevalence of non – communicable diseases is
on the rise with 19 million mortality associated with cardiovascular diseases; diabetes is
remaining a significant contributor (Vakili et al., 2015). Globally 1.7 billion people are
overweight with a substantial 315 million being obese. The population with type 2 diabetes
estimated at 250 million people and the number is projected to increase to 400 million by 2025
according to Marseglia et al. (2016).
CAPSTONE PROJECT CHANGE PROPOSAL
3
PICOT Question:
1. An increased glucose level is independently related to an increased A1C level. Does reducing
the A1C levels with specialized teaching from the nurse, practitioners, and dieticians help to
control diabetes on adult patients?
2. Do shared medical appointments improve glycemic control through Registered Nurse
Mediation?
Population:
The populations for the study are American adult patients diagnosed for type 2 diabetes,
aging 40 to 60 years old. This population is heterogeneous concerning co-morbidities and
general health status, which is essential to establishing the appropriate intervention.
Intervention:
The proposed intervention involves active Registered Nurses involvement in assisting
patients with type 2 Diabetes keep appointments, observe strict adherence to medications, dietary
and other recommendations. The nurse would help monitor record keeping with regard to fasting
blood sugars, time of taking medication in the 12 weeks during the study. The study will note the
essential parameters like blood sugar, weight, and other vital measurements at the beginning of
the study and the end of the study.
Comparison:
To determine whether the intervention is successful; A1C levels would be measured
before and after the changes in lifestyle and diet.
Outcome:
At the end of the study, it is expected that the A1C levels of adult diabetic patients that
adhere to study recommendations would reduce.
CAPSTONE PROJECT CHANGE PROPOSAL
4
Timeframe:
The research proposed to take 12 weeks.
PICOT Purpose Statement
Control of type 2 diabetes for American newly diagnosed adult patients has been
problematic (P) due to the poor lifestyle and diet, which leads to an increased glucose level.
Specialized teaching from the nurse, practitioners, and dieticians is an effective strategy to make
the patients live appropriately by eating the right food and doing exercises (I), which can enable
them to control their A1C levels (C) and live the normal life (O) within 12 weeks (T).
Education as regards to lifestyle modifications has been proved to be an effective
intervention for controlling type 2 diabetes. Kuo et al. (2015) indicate that lifestyle interventions
such as regular exercises and diet changes reduce the incidence of diabetes by 53 percent
compared to the control group. People assigned to these interventions reported reduced A1C
levels than the control group. In a similar study by Islam et al. (2014), changing the lifestyle
plays a crucial role in reducing the glucose levels, which further minimizes the cases of diabetes
by 27 percent.
Hence, there is an essential relationship between increased glucose level and increased
A1C level as well as the lifestyle change and reduced A1C levels, which leads to effective
control of diabetes. Among patients with pre-diabetes, it is worth to control their diet and do
regular exercises to help in a decrease of diabetes occurrence. Failure to prevent diabetes means
increased mortality. It is, therefore, the responsibility of each person to ensure they are living a
healthy life to lower the risk of diabetes.
CAPSTONE PROJECT CHANGE PROPOSAL
5
Literature Review
There is evidence of the efficacy of oral anti-glycemic agents in controlling diabetes. In
the PICOT statement, do socioeconomic factors, biochemical characteristics and oral
medications relate to the complications of diabetes? This question aims at investigating the
clinical features of patients with type 2diabetes on oral drugs and determines the complications
and risk factors in the patients. (Islam, 2014:7). Does uncontrolled diabetes affect cognitive
function-a predisposition to dementia? This other research question aims at finding out the effect
of uncontrolled diabetes on the risk of dementia. (Marseglia, 2016:1072)
Is there a difference in cost between Nursing practitioners and primary care physicians?
This research question aims at investigating if there is a difference in cost and level of care
between Nursing practitioners and primary care physicians. It also consists of an explored eye
examination, cholesterol, HbA1C, neuropathy, referrals, and costs between Nursing practitioners
and Primary physicians (Kuo, 2015:1982). Does medication adherence have any effect on
glycemic control among diabetic patients? This research question aims at looking at the
quantitative study of medication in relevance to diabetic patients. (Almadhoun, 2018:3).
The research questions relate closely with the aim of finding out more information and
statistics about diabetes and the precautions that can be taken to prevent its development. My
capstone project research question; does diabetes nursing visits and improving A1C levels to the
required status over 12 weeks help control diabetes? This question aims at finding out if regular
visits of the patients by nursing practitioners and improving their A1C levels will help control
diabetes.
CAPSTONE PROJECT CHANGE PROPOSAL
6
Theory of Planned Behavior
The PICOT study is grounded in the theory of planned behavior advanced by Ajzen
(1991). The approach has been used in many fields to explain behavior and intentions. The
approach is relevant in the current study because there are aspects of patients desiring health that
can be achieved through lifestyle modification, adhering to medication treatment protocols and
exercising. The motivation to modifying lifestyle is triggered to avert risks associated with
uncontrolled diabetes.
Implementation plan
The study will recruit 20 types 2 diabetic patients with uncontrolled diabetes, ten male
and ten female between the ages of 40-60 years. The respondents’ vital data will be collected at
the beginning of the intervention and monitored over twelve weeks and at the end of the study.
The data will then be analyzed to determine the effect of registered nurses in facilitating
adherence to treatment and lifestyle modifications by the study respondents as suggested by
physicians, dieticians, and pharmacists. The intervention plan is a multi-dimensional and holistic
to determine the mediating role of the registered nurse influence in diabetes control.
Potential Barriers to the Intervention
There are inherent limitations to the PICOT study; first, the respondents may drop-off
during follow-up thus affecting the survey. Secondly, the study sample size may be too small to
allow generalization. Thirdly, there is the possibility of data interference reducing reliability and
validity of the study. Lastly, the follow-up period may be too short to experience a remarkable
change in outcome. The limitations were overcome by the nurse taking leadership in
communicating and creating professional relationships with the respondents. Calls were made in
CAPSTONE PROJECT CHANGE PROPOSAL
7
advance to confirm clinic days, reminder respondents to take medication and adhere to the study
protocol.
Conclusion
In conclusion, as evident in the article, there have been various research projects that
offer factual support to the PICOT study. Research projects are relatable in a way that they aim
at finding out the best applicable methods of controlling diabetes and AIC levels.
There are reports and research findings that contribute to providing more information on
the control and management of diabetes. These include; Effect of Uncontrolled Hyperglycemia
on levels of Adhesion Molecules in Patient with Diabetic Mellitus Type 2 and the effects of
health mentoring program in community-dwelling vulnerable elderly individuals with diabetes.
The proposed PICOT study will illuminate the possible mediating role of the Registered Nurse in
improving the treatment and management of type 2 Diabetes. The results from the PICOT study
demonstrate that the part of the nurse is vital is achieving tighter glycemic control. All cases
except one recorded a real reduction in AIC.
CAPSTONE PROJECT CHANGE PROPOSAL
8
References
Almadhoun, M.R (2018) Journal of Clinical and Experimental pharmacology 8 (3), pp.1-10
American
Diabetes
Association.
(2014).
Diagnosis
and
classification
of
diabetes
mellitus. Diabetes Care, 37(Supplement 1), S81-S90. DOI:10.4172/2161-1459.1000250
Gong, Q., Zhang, P., Wang, J., Ma, J., An, Y., Chen, Y. & Chen, Y. (2018). Reducing Morbidity
and Mortality in Type 2 Diabetes by Lifestyle Intervention: 30-Year Follow-Up of the Da
Qing Diabetes Prevention Study.
http://dx.doi.org/10.3233/JAD-160266
Islam, S.M.S., Alam, D.S., & Wahiduzzaman, M., Nielsen, L.W, Fresch, G., Ferrari, U, Seisoler,
J, Rouf, H, M.A & Lechner, A. (2014). Clinical Characteristics and Complications of
Patients with Type 2 Diabetes Attending an Urban Hospital in Bangladesh. Diabetes and
Metabolic
Syndrome:
Clinical
Research
Reviews,
1-7
http://dx.doi.org/10.1016/j.dsx.2014.09.014
Kuo, Y., Goodwin, J.S. & Chen, N. Lwin, K.K., Baillargeon, J., & Raji, M.A. (2015). Diabetes
Mellitus Care Providers by Nurse Practitioners versus Primary Care Physicians, Journal
of American Geriatric Society. 63 (10), 1980-1988
Marseglia, A., Fratigioni, L., Laukka, E.J., Santoni, G., Pedersen, J., Backman, L. & Xu, W.
(2016). Early Cognitive Deficits in Type 2 Diabetes A Population-Based Study. Journal
of Alzheimer Disease. 53, 1069-1078
Ruszkowska-Giastek, B., Sollup, A., Wernik, T., Rupiecht, Z., Golalczkyk, K., Gadomska, G. &
Rosc, D. (2015). Effect of Uncontrolled Hyperglycemia on levels of Adhesion Molecules
in Patient with Diabetic Mellitus Type 2. Zhejiang University- Science (Biomedical and
Biotechnology) 16 (5), 355-361
CAPSTONE PROJECT CHANGE PROPOSAL
Vakili, S.T.T., Nezami, B.G., Shetty, A., Chetty, V.K. & Srinivasan, S. (2015). Association of
High Dietary Saturated Fat Intake and Uncontrolled Diabetes with Constipation:
Evidence from the National Health and Nutrition Examination Survey. Neurogastoral
Motil, 27 (10), 1389-1397
Wol, S.K. (2018) Journal of Korean Academy of Nursing 48 92) 182-194
9
CAPSTONE PROJECT CHANGE PROPOSAL
10
Appendix
Literature Evaluation Table
Student Name: Gregory Catania RN
Change Topic (2-3 sentences): Better Diabetic A1C control in outpatient adult clinic with
specialized nursing visits that include education, lifestyle changes, medications and diet.
Criteria
Author, Journal
(Peer-Reviewed),
and
Permalink or
Working Link to
Access Article
Article 1
Islam, S.M.S. et al.
Journal of Diabetes &
Metabolic Syndrome,
Clinical Research & Reviews
http://dx.doi.org/10.1016/j.ds
x.2014.09.014
Article 2
Article 3
Article 4
Marseglia, A. et al.
Journal of
Alzheimer’s
Disease Vol. 53,
p.1069-1078
http://dx.doi.org/10
.3233/JAD-160266
Kuo, Y. et al.
Almadhoun, M.R
et al.
Journal of
Clinical and
Experimental
pharmacology 8
(3), p.1-10
Journal of American
Geriatric Society
(10), 1980-1988
https://doi.org/10.111
1/jgs.13662
DOI:10.4172/21611459.1000250
Article Title and
Year Published
Clinical Characteristics and
Complications of Patients
with Type 2 Diabetes
Attending an Urban Hospital
in Bangladesh
(2014)
Early Cognitive
Deficits in Type 2
Diabetes A
Population Based
Study
(2016)
Diabetes Mellitus
Care Providers by
Nurse Practitioners
versus Primary Care
Physicians
(2015)
Research
Questions
(Qualitative)/Hypo
thesis
(Quantitative), and
Purposes/Aim of
Study
To find out the relationship
of social economic factors in
T2D with complications of
diabetes
To explore biochemical
characteristics in T2D and
diabetic related
complications
To find out diabetic related
complications among Pt
taking oral medications and
development of
complications
To find out if
uncontrolled
diabetes has an
effect on cognitive
function- a
predisposition to
dementia
To explore
differences in cost of
care between Nursing
practitioners
compared with
primary care
physicians
Study explored eye
examination,
cholesterol, HbA1C,
neuropathy, referrals
and costs between NP
and Primary
physicians.
The study aim: to
investigate if there is
a difference in cost
Study aim: To investigate
the clinical features of
patients with type 2 diabetes,
Purpose of the
study is to find out
if diabetes
contributes to risk
of dementia (196)
Study Aim: To
Assessment of
Medication
Adherence and
its association
with glycemic
control among
type 2 diabetes
mellitus patient
in Gaza
(2018)
To find out if
medication
adherence has
any effect on
glycemic control
among T2D
patients
Quantitative
study
CAPSTONE PROJECT CHANGE PROPOSAL
11
on oral medication and
determine the complications
and risk factors in the
patients (515).
find out the effect
of uncontrolled
diabetes on the risk
of dementia
Design (Type of
Quantitative, or
Type of
Qualitative)
Setting/Sample
Study was a cross-sectional
quantitative inquiry
The study was a
cross-sectional
quantitative study
Sample size 515 patient at
outpatient setting.
Sample size was
196 in a home for
the elderly in
Sweden
Methods:
Intervention/Instru
ments
Mixed method data collected
through questionnaire, face to
face interview, laboratory
investigations ECG, eGFR,
Blood pressure machine,
observation during outpatient
visit
The collected data was
analyzed using descriptive
statistics, and inferential
statistics. The analysis
deployed used t-test, logic
analysis and simple logic
regression analysis
Methods included
observation,
laboratory tests,
cognitive functions
tests
Analysis was done
using multivariate
linear regression to
estimate
differences and
multi-nominal
logistic regression
to examine
association
Statistical Logistic
regression model
The study revealed that even
in the best clinical setting the
control of diabetes was
suboptimal. Average HBA1C
was 8.3; hypertension 51%,
71% had uncontrolled T2D.
Uncontrolled diabetes led to
eye complications (68.9%),
chronic kidney disease
(21.3%), CVD (11.8%) and
Neurological issues (2.5)
from the study subjects.
There is need to have
consistent screening using
HBA1C goal, reduce BP and
addition of statins to
treatment regimens to help
The study reported
that uncontrolled
diabetes exposes
patient to risk of
dementia.
There was no
significant difference
the two groups
regarding costs
except Nursing
practitioners rarely
performed eye
examinations, there is
risk of Nursing
practitioners Rx
wrong medications
Control is diabetes
is essential in
reducing risks
associated with
diabetic
There is need to have
a treatment protocol
that investigates eyes,
HbAIC, CVD,
Neurological
Analysis
Key Findings
Recommendations
and level of care
between Nursing
practitioners and
primary care
physicians
Retrospective cohort
study
Evaluating data
provided by
Medicaid from
beneficiary of
primary care
N=64,354
The data collected
was coded and
analyzed with regard
to study variables
Cross-sectional
study
T2D in Gaza
attending
diabetic clinic
Sample size 148
Patients were
followed through
face to face
questionnaire,
laboratory
examination to
monitor progress
Descriptive
statistics and
inferential
statistics done.
Regression
analysis to
determine
influence of
independent
variables
The study found
out that majority
of the patients
did not comply
with treatment
instruction
leading to 56.1%
having poor
control.
Need to improve
medical
adherence to
improve T2D
glycemic control
CAPSTONE PROJECT CHANGE PROPOSAL
lower high cholesterol.
Explanation of
How the Article
Supports
EBP/Capstone
Project
The article recommends
control of blood sugar as a
means of reducing diabetic
complications. PICOT study
seeks to enhance the use of
HBA1C as measure of
controlling T2D through
education, screening and
patient management in diet &
lifestyle change because
drugs alone are insufficient.
Criteria
Author, Journal
(Peer-Reviewed),
and
Permalink or
Working Link to
Access Article
Article 5
Ruszkowska-Giastek,
B. et al.
Zhejiang
University- Science
(Biomedical and
Biotechnology)
12
complication.
Diabetic control
will delay
cognitive problems
in patient T2D
Controlling
diabetes help delay
cognitive function
impairment, nurses
can help patients
gain proper control
through education,
diet, exercise and
medication
Article 6
Vakili, S.T.T. et al.
Neurogastoral
Motil, 27 (10),
1389-1397
https://dx.doi.org/10.
1111%2Fnmo.12630
complications to
improve primary care
Nurses have a
significant role in
helping patient with
T2D manage tighter
glycemic control.
Nurses can help
patient and doctors
achieve targeted
HbAIC < 6.4
The article is
important
because
adherence to
drugs leads to
better glycemic
control
Article 7
Article 8
Wol, S.K. et al.
Journal of Korean
Academy of Nursing
48 92) 182-194
https://doi.org/10.40
40/jkan.2018.48.2.1
82
Kostev, K. et al.
Journal of
Diabetes, science
and technology
https://doi.org/10.
1177/1932296817
710477
Prescription
Patterns in
Disease control in
T2D Mellitus in
Nursing home and
Home care setting:
Retrospective
Analysis in
Germany
(2018)
To determine the
influence of
treatment setting
on diabetes
control
https://link.springer.co
m/content/pdf/10.1631
%2Fjzus.B1400218.pdf
Article Title and
Year Published
Effect of Uncontrolled
Hyperglycemia on
levels of Adhesion
Molecules in Patient
with Diabetic Mellitus
Type 2
(2015)
Association of High
Dietary Saturated Fat
Intake and
Uncontrolled
Diabetes with
Constipation:
Evidence from the
National Health and
Nutrition (2015).
The effects of health
mentoring program
in community
dwelling vulnerable
elderly individuals
with diabetes
(2018)
Research
Questions
(Qualitative)/Hyp
othesis
(Quantitative),
and Purposes/Aim
of Study
To evaluate the
concentration of soluble
forms of vascular
adhesion in patient with
controlled and
uncontrolled diabetes
type 2
Cross-sectional
Quantitative study
Hypothesis there is
no relationship
between diabetes and
constipation.
To determine the
influence of
mentoring in the
community on
health treatment
outcome in T2D
CAPSTONE PROJECT CHANGE PROPOSAL
Cross –sectional
study, randomized,
control, quantitative
design
Korea setup with
elderly at risk of
dementia, diabetes
complications 96 at
the start and 70 at
study end.
Follow up,
laboratory analysis
Quantitative
longitudinal
comparative study
Descriptive
Statistical and
inferential statistics
analysis
Statistical analysis
using Wilcoxon
tests and Chi
squared test to
compare analyze
results
There is a significant
relationship between
diabetic patients and
constipation
compared to no
diabetic subjects
Mentoring is an
effective strategy in
monitoring the
diabetic patients in
the community
There was no
significant
different between
the two groups.
The mean age at
the nursing homes
80.7 years and
those at home 74.8
years.
Patients in any set
up provided
adequate
education is
offered treatment
goals will be
achieved.
The article is vital
because nurses
attend to patient’s
outpatient and
inpatient nurses
facilitate glycemic
control.
Design (Type of
Quantitative, or
Type of
Qualitative)
Setting/Sample
The Study was a
quantitative controlled
randomized inquiry
Examination Survey
Poland sample size 62
with 35 diabetic, 27
diabetic uncontrolled
and 25 healthy subjects
Diabetic patients
non- Hispanic 6207
subjects
Methods:
Intervention/Instr
uments
Laboratory analysis,
urine, blood and kidney
function tests
Analysis
Statistical analysis
involved test for
normality, ANOVA for
variance and Pearson
correlation analysis to
test relationship among
variables
Control of diabetes
delays vascular
impairment
Physical and
laboratory
examination, BMI,
diet water intake
Descriptive Statistics
and inferential
statistical analysis
was deployed
Key Findings
13
Recommendations
Doctors need to ensure
tight control of diabetes
to prevent vascular
complications and
neuropathy
Diet is instrumental
in managing diabetes
and ensuring HbAIC
targets are reached
for tighter glucose
control.
Mentoring need to
be incorporated in
management of
T2D in the
community
Explanation of
How the Article
Supports
EBP/Capstone
Control of Diabetes
delays diabetic related
complication including
vascular impairment,
CVD and heart disease
The article is
important because
diabetic control can
help reduce
constipation in T2D
pts
The nurses are
important as
treatment facilitators
in the community
with regard to
education
Germany
comparing T2D in
nursing homes and
at home 9850
subjects /2
Analyzed, stored
data between 2011
and 2015
CAPSTONE PROJECT CHANGE PROPOSAL
14
Table of Respondents Data
No
Respondents Name
Gender
Age
1
Ann P
F
42
2
Peter T
M
3
Jane H
4
HBAIC start
HBAIC end
Remarks
30.5
7.2
6.5
Positive
56
28.5
8.3
7.8
Positive
F
57
25.8
6.9
6.3
positive
Grace O
F
43
30
9.1
7.7
Positive
5
Hilary C
F
45
29
7.7
7.7
Neutral
6
Barrack K
M
40
32.5
9.2
7.2
Positive
7
Giuliani M
M
59
28
6.9
6.2
Positive
8
Yuri J
M
60
27
7.9
6.5
Positive
9
Doris M
F
40
26
6.6
6.0
Positive
10
Fleur H
F
41
30
7.0
6.1
Positive
11
Timothy G
M
55
19
6.7
6.2
Positive
12
George H
M
46
24
7.5
6.9
Positive
13
Hannah Y
F
48
31
8.2
7.1
Positive
14
Jacobs M
M
49
27
7.8
6.9
Positive
15
Shah T
F
58
30
9.5
8.2
Positive
16
Georgas H
M
52
29.9
8.9
7.2
Positive
17
Petrobras G
M
47
28
7.3
6.3
Positive
18
Eve T
F
57
27
6.9
5.9
Positive
19
Harish P
M
53
29.5
8.8
6.4
Positive
20
Shah M
F
45
30
7.8
6.1
Positive
Table: Capstone Change Variables
BMI
CAPSTONE PROJECT CHANGE PROPOSAL
Key
BMI 30
Obese
15
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