DNP 820 Benchmark - DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project

Grand Canyon University DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project– Step-By-Step Guide

This guide will demonstrate how to complete the Grand Canyon University DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project

Whether one passes or fails an academic assignment such as the Grand Canyon University NUR 550 Benchmark – Evidence-Based Practice Project: Literature Review depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project

The introduction for the Grand Canyon University DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

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How to Write the Body for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project

After the introduction, move into the main part of the DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project

Ten Strategic Points

The 10 Strategic Points
Title of Project	Title of Project Utilizing preventive care bundle to reduce the incidence of pressure ulcers among elderly and debilitated patients.
Background Theoretical Foundation Literature Synthesis Practice Change Recommendation	Background to Chosen Evidence-Based Intervention: List the primary points for six sections. Background of the practice problem/gap at the project site The demand for quality patient care is universal across health care settings. Achieving this goal obligates nurses to identify areas where quality improvement is necessary to improve patient outcomes. Pressure ulcers are a significant health problem since they hamper care quality and safety, extend hospital stays, and increase morbidity and mortality (Darvall et al., 2018; Yap et al., 2021). In response, nurses should address such problems by implementing suitable evidence-based interventions. The current site primarily relies on standard pressure ulcer prevention strategies. Although they are somewhat effective, better interventions are needed to improve health outcomes. Significance of the practice problem/gap at the project site Pressure ulcers are among the common hospital-associated infections. Since they hamper care quality and threaten patient safety, nurses must develop appropriate and sustainable solutions. As change leaders, nurses should guide their workplace settings in implementing quality improvement projects and a similar approach is needed to reduce the incidence of pressure ulcers in the practicum site. As Darvall et al. (2018) noted, preventing pressure ulcers improve patient outcomes by reducing mortality and hospitalization. Similar outcomes will be achieved by implementing the proposed intervention to reduce the gap between the present and the desired health outcomes in the facility. Theoretical Foundations Nursing theories guide health care professionals in delivering patient care and responding to complex situations. Their primary objective is to define what nursing entails. A suitable theory for the current DPI project is Imogene King’s Goal Attainment theory. According to Butts and Rich (2021), health goals under King’s theory are achieved through transactional care. In such a care process, the nurse and patient identify the health problem together, set mutual goals, and develop mechanisms to achieve the goals. A similar approach would facilitate the effective implementation of the pressure ulcers preventive bundle. The change model appropriate for the project is Kurt Lewin’s change theory, which outlines practice change as a methodical process. Lewin described the change process as phased and achieved through three stages: unfreezing, change, and refreezing (Saleem et al., 2019). Unfreezing entails preparing people for change, while the change process entails implementing the intervention. Refreezing is primarily about solidifying the change to make it sustainable (Saleem et al., 2019). Similarly, the implementation site and patients should be prepared for the change. Appropriate mechanisms should also be implemented to solidify the change to achieve long-term benefits. Create an annotated bibliography using the “Preparing Annotated Bibliographies (APA 7th)” located in the Student Success Center. Renganathan, B. S., Nagaiyan, S., Preejith, S. P., Gopal, S., Mitra, S., & Sivaprakasam, M. (2019). Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India. Journal of the Intensive Care Society, 20(4), 309-315. https://doi.org/10.1177/1751143718804682 While repositioning patients, health care professionals should optimize turns to achieve better outcomes. In response, Renganathan et al. (2019) assessed the beneficial outcomes of improving turn compliance in patients highly susceptible to pressure ulcers. In this prospective, multiphase, multicenter trial, Renganathan et al. (2019) optimized patient turns using a monitoring system that automated alerts in the intervention group. The primary finding was a lower incidence of pressure ulcers in the intervention group than in the control group (p < 0.001). The article supports the DPI intervention by underlining the importance of patient turns and demonstrating how they can be optimized. Hassan, N., & Afzal, M., Sehar, S., & Gilani, S. A. (2020). Effects of body repositioning in immobilized patients to prevent pressure ulcer in intensive care units at public hospital, Pakistan. Iris Journal of Nursing & Care- IJNC, 2(4), 2020. http://dx.doi.org/10.33552/IJNC.2020.02.000543 In this study, Hassan et al. (2020) assessed the effectiveness of body repositioning in reducing pressure ulcer incidence. Through a quasi-experimental approach, Hassan et al. (2020) subjected all immobilized patients in a public hospital in Pakistan to a 2-hourly repositioning and recorded the incidence of pressure injuries. The main finding was a reduced incidence of pressure injuries after implementing the project. The article supports the DPI intervention by confirming the effectiveness of repositioning in reducing the incidence of pressure ulcers in critical care settings. Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621 Protective dressings are a vital component of a preventive care bundle for pressure ulcers. In response, Hahnel et al. (2020) conducted a randomized controlled trial to evaluate the effectiveness of appropriate dressing in reducing pressure ulcers. In the intervention group, areas susceptible to pressure ulcers such as the sacrum and the heels were covered using protective dressing. Patients in the control group received standard care only. Hahnel et al. (2020) confirmed the effectiveness of protective dressings by finding that pressure ulcers were lower in the intervention group (2.8%) than in the control group (10.5%). The study underlines the importance of protective dressings as a component of a preventive care bundle for reducing pressure ulcers. Zhang, X., Wu, Z., Zhao, B., Zhang, Q., & Li, Z. (2021). Implementing a pressure injury care bundle in Chinese intensive care units. Risk Management and Healthcare Policy, 14, 2435–2442. https://doi.org/10.2147/RMHP.S292579 In this quasi-experimental pre-and-post intervention, Zhang et al. (2021) assessed the effectiveness of a pressure injury care bundle in reducing the incidence of pressure injuries in ICUs. Essential components include skin care, repositioning, and continuous risk assessment. The primary finding was a reduction in pressure injury incidence from 13.86% to 10.41%. These findings confirm the beneficial effects of a preventive care bundle in reducing the incidence of pressure injuries, as conjectured in the DPI intervention. Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. International Wound Journal, 15(3), 482–490. https://doi.org/10.1111/iwj.12891 The purpose of this study was to evaluate the effectiveness of preventive dressings. Santamaria et al. (2018) conducted a randomized controlled trial where the intervention group (n= 138) received protective dressings (multi-layer silicone foam) besides standard care applied to the control group. The primary finding was a higher pressure ulcer incidence in the control group than intervention group (p = 0.004). The study supports the DPI intervention by confirming the importance of protective dressing as a protective care bundle component. . Practice Change Recommendation: Validation of the Chosen Evidence-Based Intervention Nurses have a professional mandate to improve patient care standards in health care facilities. Practice change through implementing quality improvement projects is instrumental in improving patient care outcomes. Similarly, the preventive care bundle for pressure ulcers will improve care standards in the practicum site by reducing the incidence of pressure ulcers. Therefore, it is an excellent opportunity for producing more desirable health outcomes than the current practices Summary of the findings written in this section. As a significant problem in critical care settings, the incidence of pressure ulcers can be reduced through a preventive care bundle. The annotated research stresses the need for a multicomponent care bundle for reducing the incidence of pressure ulcers in the practicum site. Recommended practices include repositioning, evidence-based skin care routine and protective dressings. Technology can be used to automate alerts to optimize patient turns and compliance during repositioning. The inference is that the care bundle should include different practices, and the explored research confirms such an approach effective in reducing the incidence of pressure ulcers.
Problem Statement	Problem Statement: It is not known if the implementation of pressure preventive bundle would impact pressure injury among the elderly and debilitated patients.
PICOT to Evidence-Based Question	PICOT Question Converts to Evidence-Based Question: In elderly and debilitated patients, will the implementation of a pressure preventive bundle reduce the incidence of pressure injury within 60 days? Evidence-Based Question: Provide the templated statement. To what extent will the implementation of a pressure preventive bundle reduce the incidence of pressure injury among elderly and debilitated patients in the long-term care facility?
Sample Setting Location Inclusion and Exclusion Criteria	Sample, Setting, Location Identify sample, needed sample size, and location (project phenomena with small numbers and variables/groups with large numbers). Sample and Sample Size: The target group is elderly and debilitated patients with pressure ulcers or at risk of their development. It is expected that 50 patients will participate and provide a reasonable sample for the DPI intervention.Setting: The setting for the study is a long-term care facility Location: suburban Maryland CityInclusion Criteria All participants should be of sound mind. Since informed consent is critical in studies involving humans, only the patients willing to participate will be included. Importantly, they should not be participating in another study. Exclusion Criteria Illiterate patients and those not meeting the inclusion criteria described above will be excluded. Besides, patients likely to leave the country during the study will also be excluded.
Define Variables	Define Variables:Independent Variable (Intervention): application of preventive care bundle for pressure ulcers (preventive interventions)Dependent Variable (Measurable patient outcome): incidence of pressure ulcers.
Project Design	Project Design: This project applies a quality improvement approach. You must be able to explain and cite the difference between research and quality improvement (one paragraph each). Quality Improvement: Quality improvement typifies the continuous strive for better health care processes and outcomes. As a result, health care professionals engaging in quality improvement seek to standardize processes to achieve better health outcomes by reducing variations (CMS.gov, 2021). In health practice, quality improvement is achieved by implementing evidence-based research.Research: Research is primarily about developing new knowledge for practice use. Generally, researchers concentrate on studying and testing phenomena to prove or disprove different hypotheses. The knowledge developed through research is the foundation of evidence-based practice. Clinicians implement such knowledge to improve health outcomes.Summarize: The current project characterizes quality improvement. The initiative seeks to reduce health variations by reducing the incidence of pressure ulcers in the long-term care facility. Findings from previous research will be implemented to improve care quality.
Purpose Statement	Purpose Statement: Provide the templated statement. The purpose of this quality improvement project is to determine if the implementation of a Care Bundle Intervention would impact pressure ulcer prevention among elderly and debilitated patients in a long-term-care facility. The project will be piloted over an eight-week period in a suburban Maryland city in a long term care facility.
Data Collection Approach	Data Collection Approach:Vital patients’ demographics like age, education level, and gender will be collected. Patients’ understanding of the pressure care bundle will also be assessed.Baseline data on the incidence of pressure ulcers in the facility will be obtained from the electronic health records (EHRs).Pre- and post-intervention data related to the incidence of pressure ulcers will be collected.Describe the step-by-step process you will use to collect the data, explain where the data will come from, and how you will protect the data and participants.Record the subjects’ vital demographics such as age and genderRetrieve baseline information from the electronic health recordsMeasure pre- and post-intervention incidence to compare outcomesMake the necessary inferences from the findings: a reduction of the pressure ulcers incidence by over 50% will be considered statistically significantSecure data from unauthorized access Potential ethical issues involving human subjects include their protection, informed consent to promote voluntary participation, and data privacy will be observed. All data will be treated as confidential and used primarily for the DPI intervention’s purposes.The project must adhere to ethical principles of beneficence, non-maleficence (no harm), and autonomy. It is designed to benefit the patients by improving health outcomes and presents no harm whatsoever. Human subjects will also be allowed to make independent decisions to avoid biased results.
Data Analysis Approach	Data Analysis Approach: Data will be analyzed through comparative data analysis. The difference between the incidence of pressure ulcers before and after the project implementation will be used to compute the percentage difference. Statistically significant outcome: a reduction of pressure ulcer incidence by 0.5 (50%) Clinically significant outcome- value above 10% reduction in pressure ulcer incidence.
References	CMS.gov. (2021). Quality measurement and quality improvement. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-#:~:text=Quality%20improvement%20is%20the%20framework,%2C%20healthcare%20systems%2C%20and%20organizations. Butts, J. B., & Rich, K. L. (2021). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning. Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784. Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621 Hassan, N., & Afzal, M., Sehar, S., & Gilani, S. A. (2020). Effects of body repositioning in immobilized patients to prevent pressure ulcer in intensive care units at public hospital, Pakistan. Iris Journal of Nursing & Care- IJNC, 2(4), 2020. http://dx.doi.org/10.33552/IJNC.2020.02.000543 Saleem, S., Sehar, S., Afzal, M., Jamil, A., & Gilani, S. A. (2019). Accreditation: Application of Kurt Lewin’s Theory on Private Health Care Organizationanl Change. Saudi Journal of Nursing and Health Care, 2(12), 412-415. doi: 10.36348/sjnhc.2019.v02i12.003 Renganathan, B. S., Nagaiyan, S., Preejith, S. P., Gopal, S., Mitra, S., & Sivaprakasam, M. (2019). Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India. Journal of the Intensive Care Society, 20(4), 309-315. https://doi.org/10.1177/1751143718804682 Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. International Wound Journal, 15(3), 482–490. https://doi.org/10.1111/iwj.12891 Yap, T. L., Horn, S. D., Sharkey, P. D., Zheng, T., Bergstrom, N., Colon-Emeric, C., … & Kennerly, S. M. (2021). Effect of varying repositioning frequency on prevention of pressure injuries in nursing home residents: TEAM‐UP cluster‐randomized clinical trial results. Research Square, 1-21. https://doi.org/10.21203/rs.3.rs-717425/v1 Zhang, X., Wu, Z., Zhao, B., Zhang, Q., & Li, Z. (2021). Implementing a pressure injury care bundle in Chinese intensive care units. Risk Management and Healthcare Policy, 14, 2435–2442. https://doi.org/10.2147/RMHP.S292579

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Sample Answer 2 for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project

The 10 Strategic Points

Title of Project

1) Title of Project

Use of Telehealth Messaging to Improve Outcomes among People with Type 2 Diabetes

Background

Theoretical Foundation

Literature

Synthesis

Practice Change Recommendation

i) Background to Chosen Evidence-Based Intervention: Background of the practice problem/gap at the project site

Diabetes is one of the several chronic conditions that have been shown to adversely impact patients’ quality of life and functionality. Its negative impact largely emanates from potential conditions which may result due to diabetes, such as stroke, heart disease, kidney disease, and blindness (Skinner et al.,2020). Diabetes impacts millions of life, limiting their ability to lead normal lives and prompting a need to come up with better strategies to prevent, manage and treat the condition (Zhang et al., 2020). Even though various approaches have been applied in efforts to minimize the adverse impacts of the condition, diabetes still ranks high among the most disabling and prevalent diseases (Zakin et al., 2019). The limited success in previous interventions creates the need for more efforts towards the management of the disease. Recent statistics showed that the world’s diabetes prevalence stands as high as close to 10% (Khan et al., 2019). Due to its chronic nature, the major interventions used in managing patients with diabetes aim at ensuring that the patients have better patient outcomes relative to factors such as glycemic control and reducing the indulgence in risky lifestyle behaviors. Such risky lifestyle behaviors have a huge potential to negatively impact the appropriate management of the disease (Maiorino et al., 2020). Even though the normal strategies have been applied at the practice site, the outcomes have not been as desired as patients still present with poorly controlled HbA1c, which exposes them to other comorbidities. As such, there is a need to focus more on diabetes management and apply more robust strategies that can help the patient better manage their HbA1c levels. Diabetes self-management education and support have been shown to improve diabetes-related patient outcomes (Azami et al., 2018). In addition, with the advancement of technology, integrating aspects like telehealth with DSMES is proving to be more promising in terms of helping patients with diabetes have better HbA1c and other diabetes-related outcomes (Nelson et al.,2021). However, the use integration of telehealth aspects such as telehealth messages is still minimal or absent in some practice settings such as the practice site. Therefore it is expected that improved patient outcomes will be the result of the integration of DSMES and telehealth messages.

ii) Significance of the practice problem/gap at the project site

The chronic nature of diabetes means that the patients have to spend a lot of money yearly to ensure improved outcomes. As such, there have been efforts to use more robust approaches, such as leveraging technological advancements to formulate better diagnosis, prevention, management, and treatment strategies (Teymourian et al.,2020). Nonetheless, individuals who are diagnosed with the condition annually are millions, while many others die yearly (Khan et al.,2019). As such, nursing has a role to play in coming up with appropriate nursing interventions which can be used to improve diabetes management, such as integrating DSMES with telehealth messages. Such strategies can go a long way toward helping the patient develop better self-management strategies to improve diabetes-related outcomes such as HbA1c levels. This is significant to the practice site as positive outcomes would mean that the practice site will develop the use of DSMES with telehealth as the standard diabetes management strategy. The implication is that the practice site will need to adopt this strategy to help improve patients’ HbA1c; on the contrary, failure to address the problem would mean that patients with diabetes would continue having poorly controlled HbA1c hence poorer health outcomes. Implementing the project is important because it could offer effective intervention on type 2 diabetes which is a significant health challenge in the American population. Other studies done using different programs of telehealth messaging suggest that they are instrumental in the management of type 2 diabetes (Fortmann et al., 2017; Dobson et al., 2020; Vinitha et al., 2019). Conducting the project is significant in confirming the importance of the proposed intervention.

iii) Theoretical Foundations:

Nursing theories are important in guiding nursing interventions focused on improving patient outcomes since, through their frameworks, facets of proposed interventions can appropriately be implemented. Therefore, the nursing theory chosen to guide this project is Dorothea Orem’s self-care theory; the major claim of the theory involves assisting others by giving them and maintaining self-care with the major focus of improving the individual’s home-level effectiveness and functioning. Orem argued that every individual can perform self-care, which entails a host of activities that the person starts to maintain their well-being, health, and life (Orem & Calnan, 1972). This theory is composed of three major supporting sub-theories. They include the theory of nursing systems, the self-care deficit theory, and the theory of self-care (Orem & Calnan, 1972).

The theory will be used as a supporting theory in the implementation of the DNP project on diabetes management. As earlier indicated, the chronic nature of diabetes requires that individuals undertake self-management activities for better outcomes. Therefore, the theory supports actions to be taken by the individuals, such as performing actions learned through educational initiatives and attending to the self-care needs for better outcomes. According to the theory, self-care is more natural to adults and can be taught; as such, this underpinning will be key in guiding the DNP project in the promotion of self-care and self-maintenance among patients living with diabetes through the DSMES integrated with telehealth messages. Another aspect of the theory is that it indicates the possibility of the patients and the caregivers having deficits in terms of sufficient information and resources. For example, the patient’s inability to undertake self-care makes them in need of support. This theory helps the project by linking what the patients need to do for better outcomes. This, therefore, fits the use of the proposed intervention to help the patients have better outcomes. Participating in the telehealth-supported diabetes self-management education program will ensure that the patients have a diminished incidence of emergency room visits.

Evidence-based change models are also important in patient intervention projects or initiatives as they help in the appropriate management of the change. As such, Kurt Lewin’s change theory was chosen to be used as part of this DNP project. The theory will be key in addressing the stakeholder concerns, attitudes, and fears. This theory has three major phases which can be used in guiding a change initiative. The three stages include unfreezing, change, and refreezing phases (Lewin, 1947). In addition, the theory states that during a change process, there are two predominant forces; the restraining and the driving forces, which bar change and foster change, respectively. As such, a change can only occur successfully when the driving forces overcome the restraining forces. The first phase of the theory is the unfreezing stage, where an urgent need or urge for change is created (Hussain et al.,2018). This stage helps the project by linking the urgent need for change and ensuring that the patients and the nurses see the urgent need to improve their patient’s HbA1c levels. Therefore, the nurses will help the patient see the need to use more effective strategies to improve their HbA1c levels hence the importance of participating in the project. The change stage involves implementing the proposed change, which involves rolling out the DSMES integrated with telehealth messages to help improve outcomes. The third stage, which is the refreezing stage, will entail making use of the intervention to be part and parcel of the normal management strategy at the practice site. As such, the healthcare professionals involved in diabetes management will be required to use the intervention and support the patients for improved outcomes.

iv) Annotated bibliography

Nelson, L. A., Greevy, R. A., Spieker, A., Wallston, K. A., Elasy, T. A., Kripalani, S., … & Mayberry, L. S. (2021). Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: evidence from the 15-month REACH randomized controlled trial. Diabetes Care, 44(1), 26–34. https://doi.org/10.2337/dc20-0961

The major aim of this study was to examine the efficacy of tailored text messages addressing medication adherence and self-care behaviors among patients with diabetes in improving their HbA1c levels. This study, known as Rapid Education and Communication for Health (REACH), was a randomized controlled trial performed in Tennessee, USA. A total of 506 participants were recruited in the study, with 253 randomized into the control group while 253 were in the intervention group (REACH). The intervention group was further randomized into the REACH-only group (127) or REACH with Family-Focused Add-on for Motivating Self-care (FAMS)- 126. The intervention group was offered monthly phone coaching delivered through text messages regarding self-care. Upon the use of the intervention, the HbA1c levels among the intervention group were found to reduce more than the intervention group (p=0.049) at six months of the study.

Fortmann, A. L., Gallo, L. C., Garcia, M. I., Taleb, M., Euyoque, J. A., Clark, T., … & Philis-Tsimikas, A. (2017). Dulce Digital: an mHealth SMS-based intervention improves glycemic control in Hispanics with type 2 diabetes. Diabetes Care, 40(10), 1349–1355. https://doi.org/10.2337/dc17-0230

Fortmann et al’s. (2019) research had the main aim of examining the efficacy of text messaging in delivering diabetes care messages among patients with diabetes in lowering the HbAlc levels. This was a randomized controlled trial performed in California, United States. A total of 126 patients with poorly controlled diabetes were recruited, with 63 randomized into the intervention group while the remaining were randomized into the control group. The intervention group received text messages with calls detailing a culturally appropriate DSME. The messages were sent two to three times a day for six months. The control group only watch videos on diabetes management at the start of the study. At baseline, both groups had poor glycemic control. Upon the use of the intervention, the intervention group showed a greater reduction in HbA1c both at three months (p=0.03) and six months (p=0.03) as compared to the control group

Dobson, R., Whittaker, R., Jiang, Y., McNamara, C., Shepherd, M., Maddison, R., … & Murphy, R. (2020). Long‐term follow‐up of a randomized controlled trial of a text‐message diabetes self‐management support program, SMS4BG. Diabetic Medicine, 37(2), 311–318. https://doi.org/10.1111/dme.14182

This research was carried out with the major aim of examining the efficacy of individually tailored text-message diabetes self-management support programs on patients’ HbA1c levels among patients with type 2 diabetes. The study was conducted in New Zealand. This was also a randomized controlled trial where a total of 293 patients were included in the study, with 177 randomized into the intervention group while 116 were randomized into the control group. The intervention group received automated text-messages self-management support on how to successfully manage diabetes. At the end of the study, there was a bigger reduction in HbA1c levels among the intervention group as compared to the control group (p<0.0001), showing the efficacy of the intervention.

Vinitha, R., Nanditha, A., Snehalatha, C., Satheesh, K., Susairaj, P., Raghavan, A., & Ramachandran, A. (2019). Effectiveness of mobile phone text messaging in improving glycaemic control among persons with newly detected type 2 diabetes. Diabetes Research and Clinical Practice, 158, 107919. https://doi.org/10.1016/j.diabres.2019.107919

Vinitha et al. (2019) conducted a study with the aim of evaluating the impact of text messaging in improving glycemic control among patients with type 2 diabetes. This was a multicenter randomized controlled trial study conducted in India. The researchers recruited a total of 248 patients, where 122 were randomized into the control group, and 126 were randomized into the intervention group. While the control group was offered the standard care, the intervention group received care supported with customized text messages three times a week. The analysis of the data showed that the intervention was efficacious. Both group groups had a significant drop in HbA1c levels (p<0.0001). However, the reduction observed in the intervention group was greater than that of the control group (p=0.044)

Riangkam, C., Sriyuktasuth, A., Pongthavornkamol, K., Kusakunniran, W., & Sriwijitkamol, A. (2021). Effects of a mobile health diabetes self-management program on HbA1C, self-management and patient satisfaction in adults with uncontrolled type 2 diabetes: a randomized controlled trial. Journal of Health Research, (ahead-of-print). https://doi.org/10.1108/JHR-02-2021-0126

The aim of this study was to determine the impact of a mobile health diabetes program (MHDSMP) intervention on diabetes self-management behavior and outcomes among patients with type 2 diabetes. This study was conducted in Thailand and was a three-arm parallel group randomized controlled trial. A total of 129 patients were recruited to take part in the study. Forty-three participants were randomized in each of the three groups; MHDSMP, telephone follow-up, and usual care. The intervention received diabetes management through text messages and telephone coaching. The study went on for three months, and by the end of the study, analysis of the data showed that there was a statistically significant reduction in HbA1c levels in the intervention group (p<0.001)

v) Practice Change Recommendation: Validation of the Chosen Evidence-Based Intervention

The usual care approaches have been applied at the practice site to manage patients with diabetes. However, patients continue to have undesirable effects, such as poor glycemic control. Therefore, this project proposes the use application of a DSMES integrated with telehealth text messages to help patients have well-controlled HbA1c levels, as indicated in research done by Nelson et al. (2021). In this research, a randomized controlled trial was used, and the patients in the intervention group who had diabetes education supported with telehealth messages had a greater reduction in HbA1c levels ((p=0.049) at six months). The results show that the intervention used by Nelson et al. (2021) is effective in reducing patients’ HbA1c levels hence a recommendation for practice change from the usual care to telehealth-supported DSMES.

vi) Summary of the findings.

The adverse impacts of diabetes as a chronic condition mean that various researchers have embarked on finding the best solutions to the condition. From the research articles in the annotated bibliography, it has been shown that the use of telehealth-supported DSMES improves patients’ HbA1c levels. In all the articles, a comparison in HbA1c levels between the intervention groups and control groups revealed that the intervention groups experienced a more significant reduction in the HbA1c levels; for instance, Nelson et al. (2021) observed a statistically significant difference (p=0.049), Fortmann et al. (2017); p=0.03, Dobson, et al. (20200; p=0.0001, Vinitha et al. (2019); p=0.004 and Riangkam et al.(2020); p=0.001

Problem Statement

2) Problem Statement:

It is not known if the implementation of DSMES with telehealth messages would impact Hb1Ac levels among adult patients with type 2 diabetes.

PICOT to Evidence-Based Question

3) PICOT Question Converts to Evidence-Based Question:

Among patients with type 2 diabetes in a nursing home, will the translation of Nelson et al’s research on diabetes self-management education and support with telehealth messages compared to the current practice improve patient HbA1c levels in 12 weeks?

Evidence-Based Question:

To what degree will the implementation of Nelson et al’s research on diabetes self-management education and support with telehealth messages impact HbA1c levels among adult patients with type2 diabetes in a nursing home in Maryland?

Sample

Setting

Location

Inclusion and Exclusion Criteria

4) Sample, Setting, Location

i) Sample and Sample Size: The sample will be obtained through convenient sampling, where a total of 30 patients with type 2 diabetes will be recruited to take part in the study. A sample calculator is to be used to get the correct number of participants.

Necessary sample= (Z-score)²*StdDev*(1-StdDev)/(Margin of error)²

One of the possible biases is selection bias, as patients to participate in the study are ones known to the nursing home. There is a potential for lack of generalizability as patients will be drawn from a single center.

ii) Setting: Skilled Nursing Facility

iii) Location: The nursing home is located in Maryland in the USA

Inclusion Criteria

§ Adult patients

§ Patients that are alert and oriented to person, place and time.

§ Patients with type 2 diabetes.

§ Patients not part of another chronic disease study.

§ Patients willing to participate.

iv) Exclusion Criteria

§ Patients below the age of 18 years

§ Patients that not alert and oriented to person, place and time.

§ Patients that are not diabetes

§ Patients participating in another study.

§ Patients who are unwilling to take part will also be excluded

Define Variables

5) Define Variables:

i) Independent Variable (Intervention): diabetes self-management education and support with telehealth messages

ii) Dependent Variable (Measurable patient outcome): HbA1c levels

Project Design

6) Project Design:

i) Quality Improvement: quality improvement refers to a project or initiative aiming at improving patient outcomes. They are formulated to help minimize the chances of errors and improve patient outcomes. They are also started to help fill care gaps that have been observed in the patient care strategies. Application of quality improvement in this project will consider existing research and translate the best evidence to help improve HbA1c levels among patients with type 2 diabetes in the practice site. In contrast to research, quality improvement involves the application of the already existing evidence to boost patient outcomes.

ii) Research: Research is a process of coming up with new ideas or knowledge to improve the current knowledge and standards of practice. It involves a systematic study of an existing problem or a clinical concern and coming up with hypotheses which are then tested to yield novel knowledge (Glasofer & Townsend). The importance of research emanates from the fact that it helps in producing scholarly evidence. Such evidence is applied in formulating guidelines and standards for nursing practice. Research is also used to come up with quality improvement efforts and initiatives.

iii) Summarize: Both quality improvement and research are key in patient care as they both focus on improving patient outcomes. Nonetheless, the two are distinct from each other. Research focuses on new knowledge creation as well as coming up with new theories. Quality improvement translates the findings from research into practice.

Purpose Statement

7) Purpose Statement:

The purpose of this quality improvement project is to determine if the implementation of diabetes self-management education and support with telehealth messages would impact HbA1c levels among patients with type 2 diabetes. The project was piloted over an eight-week period in an urban Maryland nursing home.

Data Collection Approach

8) Data Collection Approach:

i) A RedCap database will be applied to measure the patient information. The baseline characteristics and demographic data, such as the patient’s comorbidities, ethnicity, race, age, and gender, will all be recorded for every participant. The baseline HbA1c data for the patients will be obtained from the facilities, electronic health records.

ii) The Redcap database will be used to enter all the information related to the patient.

iii) The collected data will be protected from unauthorized access using the pass-worded RedCap database. Access will only be granted to those who have the provided secret password. In addition, a number will be assigned to every medical record as a way of de-identification. Use of standardized surveys and questionnaires that are reliable and valid may help to collect the data to be used in the study.

iv) Step-by-step process of data collection

1. The baseline HbA1c level data for the participants will be obtained from the facility’s EHR

2. The patients will use phones to receive interactive text messages on diabetes management.

3. The patients will be expected to send back text messages if they have understood the contents of what has been sent.

4. The HbA1c levels will be measured at the end of the intervention, and the data will be entered into the RedCap database.

v) Various steps will be taken to ensure that the patient’s rights are not infringed, and the data remains confidential. Participation will remain open and voluntary, as no patient will be coerced. The data will be de-identified, while the database with the patient data will be password protected. The data will be stored for one year after graduation, followed by disposal to protect patients further.

vi) This project also intends to follow the Belmont principles. Hence, it will ensure that harm is prevented. Participation will also remain totally voluntary. The patients will also be treated with respect while respecting their autonomy. To adhere to the principles by remaining open to the participants and sharing every information that concerns them.

Data Analysis Approach

9) Data Analysis Approach:

i. The data will be analyzed using suitable software. Central measures of tendency, such as average, mean, and median, will be applied to summarize the patient’s characteristics.

ii. Descriptive statistics will be used to analyze the demographic data, the mean, median and standard deviations.

iii. While some data will be obtained from the EHR, the project data for comparison will be measured by the nurses, and comparison will be made to determine the efficacy

iv. Paired sample t-test will be used to obtain the differences between pre and post-intervention

v. A statistician will be used in the statistical analysis and appropriate interpretation.

Various biases are expected in this project. For example, in case a positive effect is observed, there could be a possibility that such results may not be all down to the intervention. Therefore, as a way of mitigating this, a study design will be used to ensure that the patients only used the indicated intervention.

References

Azami, G., Soh, K. L., Sazlina, S. G., Salmiah, M., Aazami, S., Mozafari, M., & Taghinejad, H. (2018). Effect of a nurse-led diabetes self-management education program on glycosylated hemoglobin among adults with type 2 diabetes. Journal of diabetes research, 2018. https://doi.org/10.1155/2018/4930157

Glasofer, A., & Townsend, A. B. (2021). Determining the level of evidence. Nursing, 51(2), 62–65. https://doi.org/10.1097/01.nurse.0000731852.39123.e1

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Maiorino, M. I., Signoriello, S., Maio, A., Chiodini, P., Bellastella, G., Scappaticcio, L., … & Esposito, K. (2020). Effects of continuous glucose monitoring on metrics of glycemic control in diabetes: a systematic review with meta-analysis of randomized controlled trials. Diabetes Care, 43(5), 1146-1156. https://doi.org/10.2337/dc19-1459

Orem, D. E., & Calnan, M. E. (1972). NURSING. Nursing Management (Springhouse), 3(1), 43-46. https://doi.org/10.1097/00006247-197201000-00013

Skinner, T. C., Joensen, L., & Parkin, T. (2020). Twenty‐five years of diabetes distress research. Diabetic Medicine, 37(3), 393-400. https://doi.org/10.1111/dme.14157.

Teymourian, H., Barfidokht, A., & Wang, J. (2020). Electrochemical glucose sensors in diabetes management: An updated review (2010–2020). Chemical Society Reviews, 49(21), 7671–7709. https://doi.org/10.1039/D0CS00304B

Zakin, E., Abrams, R., & Simpson, D. M. (2019, October). Diabetic neuropathy. In Seminars in neurology (Vol. 39, No. 05, pp. 560–569). Thieme Medical Publishers. DOI: 10.1055/s-0039-1688978

Zhang, Y., Lazzarini, P. A., McPhail, S. M., van Netten, J. J., Armstrong, D. G., & Pacella, R. E. (2020). Global disability burdens of diabetes-related lower-extremity complications in 1990 and 2016. Diabetes Care, 43(5), 964–974. https://doi.org/10.2337/dc19-1614