CAPSTONE123

MSN Capstone Project Proposal Form This is a building assignment that you will be completing over Week 1 through Week 9. This is a stepwise project proposal assignment in which you will complete one (1) section each week for your MSN Capstone Project Proposal. By the end of the Week 9, this form will have been filled in completely and your MSN Capstone Project Proposal will be completed. It is important that you keep up with the Weekly Assigned Section. Each section is graded separately on a weekly basis while the final completed form will be graded with an overall grade. Each week the student will receive feedback from the instructor and the student is expected to incorporate the instructor feedback to edit and improve the weekly sections. The Week 9 final Capstone Project Proposal with be based on students incorporating the instructor’s weekly feedback.

How to use this form.  Must use the same form for all sections. The purpose is to have a completed the entire form by

the end of the course.  Complete the week’s section with the requested information.  There are suggested word counts for each weekly section to provide you with an idea of what is

expected.  You are to write in full sentences, paragraphs, correct grammar, and spelling.  Use APA formatting with citations and references list.  Refer to the MSN Capstone Project Proposal Form Example found in Week 1 and in the Course

Resources tab.  Do not delete or edit the week section instructions.  Do not lock the form because that will stop you from editing and revising within the form.  Leave NO blank sections. All sections are graded separately.  You may work ahead; however, the instructor will only grade the week’s section due for the

assigned week and the form must be submitted each week.  Read the item descriptions carefully. Items request very specific information. Be sure you

understand what is requested.  Use primary sources for any references. Textbooks are not acceptable as references.

Late Assignments: Students will receive a 10-point grade reduction for each day the assignment is submitted past the due date. After three (3) days past the due date, students will receive a zero (0) for that weekly section but must complete for the final Week 9 grading.

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MSN Capstone Project Proposal Form

Student Name Melinda Powell

MSN Program Family Nurse Practitioner - PMC

Project Title Improving Nurse Practitioners use and availability of Diabetic resources for patient education during Primary Care visits to increase compliance.

Week 1 State Your Clinical Question

[100 to 150 words]

 State your clinical question or topic for your capstone project proposal.  What issue is the question/topic addressing?  What are the reasons you selected this question/topic?

Though there are assessment tools available for nurse practitioners to use to help identify a health issue or

concern, often times the assessments may be overlooked or not included in the clinical visit which is a lost

opportunity to improve health or outcome. On the opposite spectrum of identification of a health risk or problem

during a clinical visit, resources are needed to help reinforce prevention strategies, risks and benefits of treatment,

immediate education, and guidance post visit.

This proposal seeks to improve the use of available assessment tools in clinic visits and increase available

resources for education to improve patient compliance for better health outcomes. The assessment tools that

should be included in visits will be used at all visits with patient centered resources and educational tools

available in the clinic for immediate remediation following the assessment results. The assessments tools and

resources will be based on current evidenced based practices and guidelines for diabetic patients health.

This topic was chosen due to the increase in diabetes, and mental health uptick over the past 2 years (during the

COVID-19 pandemic) in America. The COVID-19 pandemic affected the health of Americans while people faced

the risk of a acquiring the life-threatening virus (Laffin, 2021). During the pandemic people faced increase stress

levels, increase risks to mental health, increased blood pressure, and increase in diabetes (Laffin, 2021). During

the pandemic where there has been an increase in diabetes, general stress and social isolation due to the pandemic,

with a significant impact on disease management Fischer et al., 2020).

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Week 2 Background Information

[200 to 250 words]

Address the following questions/bullets in completing this section:  Start at the starting point - What, Where, When, Why, and How?  What is known about this topic or what is the evidence on this topic (Scoping Search)?  What is the outcome of interest?  What are the gaps in our understanding or knowing related to this topic?

The issue this project seeks to address is the lack of resources readily available in the clinic settings that are lay enough for

patients to clearly understand the diet and activities that would help improve their diabetes management. For optimal type 2

diabetes control, managing diabetes and teaching patients’ diabetes self-management skills are crucial (Chester, Stanely, &

Geetha, 2018; Hashim et al., 2021). In the clinic (as an FNP student) a patient wanted a list of specific foods to purchase that

would assist in adherence to the ADA diet. The tools in the clinic were not specific enough for the patients’ needs or

understanding. The patient found the current tools overwhelming, wordy, and to generalized about the diabetic diet and

exercises. Never receiving a request like this and recent research suggesting an increase in diabetes over the past two years

may indicate the need to provide diabetic diet information in the simplest form for patients to clearly and concisely understand

what foods are appropriate for diabetics.

In that visit, finding what the patient needed should have been easier but determined not to let her leave without a true list

of what she can buy that would help increase her compliance was not an option and she patiently waited as the gathering of

data sources was occurring. According to Chester, Stanely, and Geetha (2018), diabetes self-management education (DSME)

and support require time and resources, however this information should have been available at her request. Upon return to

the clinic, no change was made to have this type of information available for diabetics. This simple food list may be a

supplemental tool, and a positive reinforcement easily understood by the patient. There is an abundance of educational

material and tools to use for diabetic patient education, however, very few guides compile the information in a practical way to

convey the information to the patients (Chester, Stanely, & Geetha, 2018). What the patient needed or even wanted was

simplistic sources of information that makes change seem possible.

Week 3

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Literature Search Strategies [150 to 200 words]

Provide details of your exhaustive search process. Be certain to list:

 Databases searched.  All the keywords or search phrases used.  How many articles in total that were found?  List the inclusion/exclusion criteria.  Provide the number of articles that were retained and a description on why those

articles were retained.  Consider using a flowchart to outline the search process.

MEDLINE, CINAHL, and ProQuest, databases were searched from January 2016 to December 2021. Search terms were

identified from existing reviews. Free-text terms for searching titles, abstracts, and key words were combined with database-

specific terms for the following: Diabetic patient dietary education AND resources AND in primary care tools OR Diabetic

patient Education simple tools and resources Full-text electronic limits were applied to database searches. Inclusion criteria

included studies with diabetes type 2 patient dietary education resources and tools while exclusion criteria included articles

that focused on inpatient diabetic education. A total of 873 articles were identified and included 61 evidenced based

healthcare, and 26 literature reviews. Articles meeting the inclusion criteria resulted in 88 for scanning. Still scanning and

determining which articles should be removed. The total number of articles remaining is 88 and will eliminate the articles that

are not focused on the diabetic education tools exclusively, those that are weak in quality, methodology, and ineffective results

for improving patients HgA1c and understanding of diabetic diet.

Week 4 Literature Review [500 to 1000 words]

Conduct a review of the literature. Include at least five (5) research articles and/or evidence- based guidelines. Address the following questions/bullets in completing this section:

 Conduct a review of the literature.  Provide the highlights from the research.  Synthesize the literature on the topic.  Summarize how the project will contribute to knowledge by filling in gaps, validating, or

testing knowledge.  Cite references in this section per APA and list the reference in the References section

at the end of the form.

Primary care has become a center point for diabetes management with primary care providers delivering clinical care to

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approximately 90% of individuals with type 2 diabetes, which is likely to increase over time (Muchiri, et al., 2021; Shrivastav,

2018). With the rapidly increasing diabetes population, it is essential that primary care practitioners thoughtfully use this time

to successfully manage these patients (Shrivastav, 2018). One of the biggest challenges is the complexity of diabetes

management with the need for Diabetic Self-Management Education (DSME), which is considered a critical element in the

treatment for people with diabetes and prediabetics (Powers et al., 2020). The purpose of DSME is to provide those with

diabetes knowledge, skills, and confidence be empowered to self-manage and improve their disease (Powers et al., 2020).

DSME includes partnering with their health care team, making informed decisions, solving problems, developing personal

goals and action plans, and coping with emotions and life stresses (Powers et al., 2020).

DSME has proven to be cost-effective by reducing hospital admissions and readmissions, decreased health care costs, and

decreased complications. DSME/S improves hemoglobin A1c by as much as 1% in people with type 2 diabetes and has a

positive effect on other clinical, psychosocial, and behavioral aspects of diabetes (Hashim et al., 2021; Powers et al, 2020;

Powers et al., 2016). DSME is reported to reduce the onset and/or advancement of diabetes complications, to improve quality

of life, and lifestyle behaviors such as having a more healthful eating pattern and engaging in regular physical activity, increase

healthy coping, and decrease the presence of diabetes-related distress, and depression. These benefits reaffirm the

significance and value of DSME (Hashim et al., 2021; Powers et al, 2020; Powers et al., 2016).

A consensus report was created and directed toward health care providers (physicians, nurse practitioners, physician

assistants) that outlined the benefits of DSME (American Diabetes Association, 2021; Powers et al., 2021). This Consensus

Report focuses on a component of diabetes care that is often not accessed or utilized effectively which is the DSME (Powers

et al., 2021). DSME is identified as one of the essential elements of comprehensive diabetes medical care, along with medical

nutrition therapy (American Diabetes Association, 2021; Powers et al., 2021). DSMES improves health outcomes and quality

of life and is cost effective.

Overall, a call to action for primary care teams to engage needed resources and to effectively and efficiently manage and

address diabetes and the barriers that result in therapeutic inertia created by health policy, health systems, providers, people

with diabetes, and the environment, including social determinants of health, which encompass the conditions in which people

live, work, learn, and play (American Diabetes Association, 2021; Powers et al., 2021). To provide effective treatment and care

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for diabetics and prediabetics, all stakeholders will need to make this a priority. In general, providers should seek evidence-

based approaches and tools that improve the clinical outcomes and quality of life of patients with diabetes (American Diabetes

Association, 2021; Powers et al., 2021).

Week 5 PICOt Question

State your PICOt question here. Use the elements of the PICOt in separate sections below to describe each component.

 Population – Provide the description of the targeted population.  Intervention – Describe your evidence-based intervention.  Comparison – What is currently happening?  Outcomes – List at least two (2) measurable outcomes.  time – What duration of the study for the project? (e.g., usually 6 months or 3 months)

Population(P): NP’s at 20 local primary care offices on the west side of the city will identify diabetic DSME tools and resources that are readily available in the office for newly diagnosed pre-diabetic and diabetic patients and determine if these tools are simplified enough to meet their patients’ needs.

Intervention (I): Locate DSME tools and resources that are evidenced based, and ensure these tools are in the primary care office for prediabetes and diabetic patients based on the simplicity of the education level of the population of that clinic.

Comparison (C): There are various tools and resources available as DSME, however, the NPs challenge will be to bring the tools and resources to a consensus and determine which tools make DSME simple for the patient to follow and understand that can be used by the team during a clinic visit.

Outcomes (O): Increase compliance with diabetic diet as evidence by decrease in HgA1c from the patients current HgA1c, BMI close to Ideal body weight, reduction in diabetic complications, decreased hospitalization due to noncompliance, microalbumin/creatinine ratio, and lipid panel, decrease in escalation of blood pressure medications, anti-diabetic medications, and sustained renal function.

Time (t): diabetic patients who receive these simplified tools will exhibit the outcome over 1 year from original testing.

Week 6 P (Target Population)

[75 to 100 words]

Address the following questions/bullets in completing this section:  Who is your target population?  Describe your population, i.e., age, ethnicity, gender, condition/diagnosis, etc.?  Describe the setting where this project be implemented?

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The population for this study is 205 nurse practitioners from various internal medicine and general practice offices and

within the west side of the city that are affiliates of local hospitals and private practices. Years of experience working with pre-

diabetics and diabetics that range from novice entering as an FNP to 40 years of practice. The patient population will be pre-

diabetic and diabetic ranging in age from 18 years to 99 years. The average age is for prediabetes being 35 years and the

average age for diabetes being appropriately 40 years. The setting for this project will be various internal medicine and general

practice offices on the west side of the city that are affiliates of local hospitals and private practices.

Week 7 I (Intervention)

[100 to 200 words]

Address the following questions/bullets in completing this section:  What are you planning to investigate or implement as a policy/process or program?  What are you doing that is different than what is currently happening?  List 2-3 potential actions that will be applied in this practice change.

NOTE: Be very specific in your description.

This project will evaluate the effectiveness of implementing evidenced based, best practice simplified DMSE tools for

prediabetes and diabetic patients in the primary care setting by with nurse practitioners on a skilled nursing unit. Currently

there is no single standardized tool for diabetic education though there are various tools and innumerous amounts of

information available for diabetic patients there is not a simplified standardized tool that simplifies and summarizes the

education needed in primary care visits for prediabetes and diabetic patients. The intervention for this project will be the

implementation of a best practice protocol using the evidence-based recommendations from the American Diabetic

Association and the CDC, on the pharmacological management, diet, lifestyle changes, and moderate exercise to reduce the

progression of diabetes in prediabetes and diabetic patients. A team of stakeholders and clinicians will meet as a team to

review current tools and create a simplified tool that may be universally used during primary care visits. The tool will be used

primary to help direct prediabetes and diabetic patients in diet, lifestyle changes, exercise, and pharmacological agents used

to prevent and treat diabetes to prevent the complications and advancement of the disease.

Potential interventions include:

1. Standardized prediabetes and diabetes education tools in primary care

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2. Simplified dietary list for prediabetic and diabetic patients to use as a guide when grocery shopping

3. Simplified dietary substitutes for favorite foods that are suitable for diabetics

4. Simple and gradual changes to lifestyle that will help prevent the long-term effects of diabetes

5. Describe the medications used to prevent and treat diabetes

6. Describe the long-term effects of diabetes and the complications when not managed or non-adherence

7. Describe optimal outcomes when patient participates and make optimal modifications to diet and lifestyle and medication

adherence

*For purposes of this Proposal Project Form the assumption will be that the C (Comparison Group) is ‘traditional care or current care’

Week 8 O (Outcomes to be measured)

[100 to 150 words] Every project is required to have an evaluation plan. Address the following questions/bullets in completing this section:

 Which 2-3 outcomes are expected for your project?  What outcomes will be measured?

o How do you plan to do this? o What tool will you be using to measure your outcome(s)? o What data will be used to validate success of the project?

Be sure your outcomes link to the identified problem.  How will you know if your intervention resulted in change?

Interventions for this project will be evaluated as an evidenced based improvement project. The expected outcomes for

this project will include:

1. Patient’s HgA1c should decrease by 0.5 % to 3% in 1 year compared to their initial HgA1c

2. Patient will not have hospitalizations r/t diabetic complications or disease progression in 1 year compared to previous

year

3. Patient will have 5 -10 lb. weight reduction within 1 year compared to previous year

This project may also use the Diabetes Severity Score (DISSCO) which is a computer algorithm that combines information

routinely collected in primary care. The higher the DISSCO score the greater the risk of hospital admission or death therefore

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this tool could be used at the start of the project and 1 year later reassess using the DISSCO tool. The primary validating tool

will be the patients’ labs such as the HgA1c, microalbumin, BMI, renal function, lipid panel, and no escalation in disease

progression.

Week 9 & References

9.1 Conclusion [200 to 250 words]

 Provide a summary for your MSN Capstone Project.  Select and provide the rationale for three (3) competencies or specialty standards that you would expect

to use in implementing this project [List of your specialty competencies are listed in the Week 9 Reflection Post]

9. 2 References [Minimal of 5 research articles and references are paged on the last page.]

 Add your references in APA formats on the last page.

It is challenging to be a primary care provider and provide resources and education to patients on various aspects of their

health to increase their knowledge and self-management capabilities. Patients that are prediabetic and diabetic are often

provided numerous amounts of education from various health care personnel, so it is imperative that provider re-evaluate the

resources and ensure they are meeting the needs of the patient population. The challenge to provide relevant and simplified

educational instructions and resources to empower prediabetic and diabetic patients to make modifications that will improve

their health. Current educational material is not simplified nor standardized for diabetic education. Simplified evidenced based

educational resources for prediabetic and diabetic patients may result in effective positive outcomes. National Organization for

Nurse Practitioner Faculty (NONPF) competing that will be used with implementing this project include: § Competency 3 –

Quality Competencies – This project will be using the quality competency in the implementation of evidenced based practice

for quality improvement. This project will use my leadership and patient advocacy skills as a change agent. § Standard 15.–

Resource Utilization– This project will be using the resource utilization by evaluating, and revising clinical resources for

improving prediabetics and diabetics health through simplifying educational resources in primary care. The question most

important to this project is how well do diabetics understand the resources that are currently provided, and could this be

simplified for better health outcomes? § Standard 3. Outcomes Identification – This project will be evaluating the outcomes

related to improved and simplified diabetic educational resources which will reduce disease progression, comorbidities and

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improve associated organ function and lab values, therefore creating a healthier population.

References in APA format should begin on the next page

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References [Provide at least 5 References]

Ali, K. M., Bullard, M. K., Imperatore, G., Benoit, R. S., Rolka, B. D., Albright, L. A., & Gregg, W. E., (2019). Reach and Use of

Diabetes Prevention Services in the United States, 2016-2017. JAMA Network,2(5):e193160.

doi:10.1001/jamanetworkopen.2019.3160

American Diabetes Association. (2016). Strategies for Improving Care. Diabetes Care, 39(1), S6–S12

Bowen, M. E., Cavanaugh, K. L., Wolff, K., Davis, D., Gregory, R. P., Shintani, A., Eden, S., Wallston, K., Elasy, T., & Rothman, R.

L. (2016). The diabetes nutrition education study randomized controlled trial: A comparative effectiveness study of

approaches to nutrition in diabetes self-management education. Patient education and counseling, 99(8), 1368–1376.

https://doi.org/10.1016/j.pec.2016.03.017

Chester, B., Stanely, W. G., & Geetha, T. (2018). Quick guide to type 2 diabetes self-management education: creating an

interdisciplinary diabetes management team. Diabetes, metabolic syndrome and obesity: targets and therapy, 11, 641–

645. https://doi.org/10.2147/DMSO.S178556

Coppell, K. J., Abel, S. L., Freer, T., Gray, A., Sharp, K., Norton, J. K., Spedding, T., Ward, L., & Whitehead, L. C. (2017). The

effectiveness of a primary care nursing-led dietary intervention for prediabetes: a mixed methods pilot study. BMC

family practice, 18(1), 106. https://doi.org/10.1186/s12875-017-0671-8

Fisher, L., Polonsky, W., Asuni, A., Jolly, Y., & Hessler, D. (2020). The early impact of the COVID-19 pandemic on adults with

type 1 or type 2 diabetes: A national cohort study. Journal of diabetes and its complications, 34(12), 107748.

https://doi.org/10.1016/j.jdiacomp.2020.107748

Hashim, A. S., Yusof, M. B., Saad, A. H., Ismail, S., Hamdy, S., & Mansour, A. A. (2021). Effectiveness of simplified diabetes

nutrition education on glycemic control and other diabetes-related outcomes in patients with type 2 diabetes mellitus.

Clinical Nutrition ESPEN, 45, 141-149. DOI: https://doi.org/10.1016/j.clnesp.2021.07.024

https://doi.org/10.2337/dc16-S004

Laffin, L., Kaufman, H., Chen, Z., Niles, J., Arellano, A., Bare, L., & and Hazen, S., (2021). Rise in blood pressure

observed among us adults during the COVID-19 pandemic. Circulation American heart Association

Journals. 45(3), 235–237. https://doi.org/10.1161/CIRCULATIONAHA.121.057075Circulation.

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Muchiri W. J., Gericke, J. G., & Rheeder, P. (2018). Adapting a diabetes nutrition education programme for adults with type 2

diabetes from a primary to tertiary healthcare setting. South African Journal of Clinical Nutrition 34(1), 9-17

https://doi.org/10.1080/16070658.2019.1632127

Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D.,

Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L. M., & Uelmen, S. (2020). Diabetes Self-management Education

and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the

Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy

of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the

American Pharmacists Association. The Diabetes Educator, 46(4), 350–369.

https://doi.org/10.1177/0145721720930959

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., Maryniuk, M. D., Siminerio, L., & Vivian, E.

(2016). Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the

American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and

Dietetics. Clinical diabetes: a publication of the American Diabetes Association, 34(2), 70–80.

https://doi.org/10.2337/diaclin.34.2.70

Shrivastav, M., Gibson, W., Jr, Shrivastav, R., Elzea, K., Khambatta, C., Sonawane, R., Sierra, J. A., & Vigersky, R. (2018). Type

2 Diabetes Management in Primary Care: The Role of Retrospective, Professional Continuous Glucose

Monitoring. Diabetes spectrum: a publication of the American Diabetes Association, 31(3), 279–287.

https://doi.org/10.2337/ds17-0024

Edupuganti, S., Bushman, J., Maditz,R., Kaminoulu, P., & Halalau, A. (2019). A quality improvement project to increase

compliance with diabetes measures in an academic outpatient setting. Clinical Diabetesand Endocrinology, 5(11).

https://doi.org/10.1186/s40842-019-0084-9

Zghebi, S. S., Mamas, M. A., Ashcroft, D. M., Salisbury, C., Mallen, C. D., Chew-Graham, C. A., Reeves, D., Van Marwijk, H.,

Qureshi, N., Weng, S., Holt, T., Buchan, I., Peek, N., Giles, S., Rutter, M. K., & Kontopantelis, E. (2020). Development

and validation of the Diabetes Severity Score (DISSCO) in 139 626 individuals with type 2 diabetes: a retrospective

cohort study. British Medical Journal, 8(1), 1-11. http://drc.bmj.com/content/8/1/e000962.abstract

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