Posted: October 27th, 2022

Assignment 1-3

10 Strategic Points Table Comment by Tabitha Garbart: Great job! After you make the revisions this will become Appendix A of your proposal, so go ahead an insert it in your template. You will also need it as a separate document to submit to IRB next quarter.

The 10 Strategic Points

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Broad Topic Area

1.

Broad Topic Area/Title of Project:

Effectiveness of Diabetes Mellitus Type 2 Self-Management Education

Literature Review

2. Literature Review:

1. Background of the Problem/Gap:

· Type 2 diabetes mellitus (T2DM) has become one of the most prevalent chronic diseases in the U.S. and the world at large. It has become the seventh highest cause of mortality and morbidity in the U.S. (CDC, 2021). These patients are often required to perform self-care activities. Diabetes self-management can significantly improve the health and well-being of T2DM patients.

· Evidence shows that adhering to self-management activities can reduce the complications resulting from diabetes (Captieux et al., 2018). Goldenberg et al. (2020) observes that diabetes self-management education is a reliable intervention in diabetes care and is endorsed by credible health care organizations such as the American Diabetes Association.

· According to the reviews, DSME positively impacts the quality of life in all domains, reducing cardiovascular risk reduction, macro and microvascular complications of diabetes mellitus type 2 amongst patients (Setyawati et al., 2020).

1. Theoretical Foundations (models and theories to be the foundation for the project):

· The Health Belief Model and Self-Efficacy theory deliver the theoretical framework for health promotion and self-care management in patients with T2DM (Beckerle & Lavin, 2013; Campbell et al., 2011; Hurley, 1990; Peyrot, Peeples, Tomky, Charron-Prochownik, & Weaver, 2007; Skovlund & Peyrot, 2005). An education program ought to have a foundational assessment of both an individual’s perceived disease state and the person’s capability to manage diabetes effectively.

· Self-efficacy is the belief in one’s ability to accomplish something and individuals who gain self-efficacy and feel that they have more control of their behavior end up more likely to carry out positive behaviors for their well-being (Bandura, 1977).

1. Review of Literature Topics with Key Themes and Subthemes
Comment by Tabitha Garbart: It is not really clear about which are themes and which are subthemes. Remember you are to have two themes with three subthemes per theme. Subthemes should be in italics and themes not.

Diabetes Education

· Individual versus group diabetes education: Assessing the evidence. (Lawal & Lawal, 201

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); Can Secure Patient-Provider Messaging Improve Diabetes Care? Diabetes Care (Sukyung, Chi, Panattoni, Palaniappan, & Chung, 2017).

Population Diabetic Education:

· Harrington, C., Carter-Templeton, H., & Appel, S. J. (2017). Diabetes self-management education and self-efficacy among african american women living with type 2 diabetes in rural primary care. Journal of Doctoral Nursing Practice, 10(1), 11-16. 10.1891/2380-9418.10.1.11

·

Huntriss, R., & White, H. (2016). Evaluation of a 12-week weight management group for people with type 2 diabetes and pre-diabetes in a multi-ethnic population. Journal of Diabetes Nursing, 20(2), 65-71 7p. Retrieved from http://proxy.library.vcu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,cookie,uid&db=ccm&AN=113642972&site=ehost-live&scope=site

.

· Lawal, M., & Lawal, F. (2016). Individual versus group diabetes education: Assessing the evidence. Journal of Diabetes Nursing, 20(7), 247-250. Retrieved from http://proxy.library.vcu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,cookie,uid&db=ccm&AN=117093160&site=ehost-live&scope=site.

Certifications:

· National Committee for Quality Assurance. (2015). HEDIS report card comprehensive diabetes care. Retrieved from http://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2015-table-of-contents/diabetes-care.

· US Department of Health and Human Services. (2016). Diabetes–healthy people 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes.
· Virginia Department of Health. (2017). Diabetes Burden in Virginia. Retrieved from http://www.vdh.virginia.gov/content/uploads/sites/75/2016/12/Diabetes-Burden.
1. Summary
· Gap/Problem: Studies found that DSME increased knowledge, increased self-management motivation, improved diabetes care behaviors, and increased social support. However, a significant number of patients fail to perform adequate self-management (Carpenter et al., 2019). Therefore, a question arises concerning the effectiveness of interventions on self-management behaviors of patients with T2DM.
· Prior studies: Evidence shows that adhering to self-management activities can reduce the complications resulting from diabetes (Captieux et al., 2018).
· Quantitative application: Sources of data exist to collect numerical data on the rate of improved patient-perceived self-efficacy.
· Significance: Patient diabetes knowledge, DSM, adherence medications, self-efficacy, and quality of life can significantly be improved by DSME.

Problem Statement

3. Problem Statement:

It is not known if or to what degree the implementation of an American Association of Diabetes Educators Seven (AADE7) Self-Care Behavior individualized DSME program would impact self-efficacy when compared with no DSME among adults ages 65 and older diagnosed with diabetes mellitus in a long-term care facility in Central Alabama. The effectiveness of DSME in diabetes self-care has been established by research. However, many patients fail to perform adequate self-management. The evidence available in the literature is divided across different DSME programs, settings, patient groups, and geographic locations, making it hard to generalize to all populations.

Clinical/
PICOT Questions

4. PICOT Questions or Clinical Question:

· (P) In adults ages 65 and older diagnosed with diabetes mellitus, type 2 (I), how does implementing the American Association of Diabetes Educators Seven (AADE7) Self-Care Behavior individualized DSME program (O) affect self-efficacy (C) compared with no DSME in adults ages 65 and older diagnosed with diabetes mellitus, type 2 at a long-term care facility in Central Alabama (T) over 4 weeks?

Clinical Question:

· To what degree does the implementation of an American Association of Diabetes Educators Seven (AADE7) Self-Care Behavior individualized DSME program impact self-efficacy compared with no DSME among adults ages 65 and older diagnosed with diabetes mellitus, type 2 in a long-term care facility in Central Alabama over 4 weeks? Comment by Tabitha Garbart: How are you going to measure this? Please e-mail this to me after you correct everything. We need to make sure this is solid. You have to have a measurable patient outcome. I don’t know that this will qualify. Is the intent to lower HGA1C or BGL? Comment by Pam Hayes: The intent is that self-efficacy score would improve from baseline for patients who participated in the DSME program. The project will use the

Self-Management Resource Center Self-Efficacy for Diabetes scale

pre and post intervention to evaluate increase in score.

Sample

1. Sample (and Location):

1. Location: Central, Alabama

1. Population: Adults age 65 and older diagnosed with Diabetes Mellitus Type 2

1. Sample: 10 participants Comment by Tabitha Garbart: How come 10? That is the minimum that you can do but you need to do a G power analysis to determine what your sample size should be to get a 95% confidence interval. That is your goal and if you get less that’s fine but you at least need 10 to have a successful project.

1. Inclusion Criteria

3. Patients diagnosed with Diabetes Mellitus Type 2

3. Patients age 65 and older

1. Exclusion Criteria

· Patients not diagnosed with Diabetes Mellitus Type 2

· Patients younger than 65 Comment by Tabitha Garbart: Also put information about the staff that will be participating in your project.

· Patients diagnosed with Type 1 Diabetes

Define Variables

1. Define Variables:

1. Independent Variable (Intervention): American Association of Diabetes Educators Seven (AADE7) Self-Care Behavior individualized DSME program

Dependent Variable: Self-Efficacy for Diabetes Mellitus patients in a long-term care facility Comment by Tabitha Garbart: We need to make sure we have a measurable patient outcome as the dependent variable.

Methodology and Design

1. Methodology and Design:

This project will use a quantitative methodology with a quasi-experimental design.

Purpose Statement

1. Purpose Statement
: Comment by Tabitha Garbart: Align this to your clinical question once you make the changes.

The purpose of this quantitative quasi-experimental study is to determine to what degree does the implementation of an American Association of Diabetes Educators Seven (AADE7) Self-Care Behavior individualized DSME program impact self-efficacy compared with no DSME among adults ages 65 and older diagnosed with diabetes mellitus, type 2 in a long-term care facility in Central Alabama over 4 weeks.

Data Collection

1.

Data Analysis Approach

1. Data Analysis
Approach: Comment by Tabitha Garbart: You are missing the data collection section that should be right above this one.

Post intervention Self Efficacy questionnaires will be compared to the baseline Self-Efficacy for diabetes questionnaires. Descriptive statistics will describe the sample characteristics and variable results.

The ANOVA analysis will determine the impacts of the training on participants. Independent t-tests will help determine the differences between the interventional and control groups for AADE7 Self-Care Behavior individualized DSME. Comment by Tabitha Garbart: Might have to revise once you consider your measurable patient outcome.

References

American Association of Diabetes Educators. (2014). AADE7TM self-care behaviors position statement. Retrieved from https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/publications/aade7_position_statement_final ?sfvrsn=4

American Association of Diabetes Educators. (20190.Project vision. Retrieved from https://www.diabeteseducator.org/about-aade/project-vision.

Captieux, M., Pearce, G., Parke, H. L., Epiphaniou, E., Wild, S., Taylor, S. J., & Pinnock, H. (2018). Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews. BMJ open, 8(12), e024262. https://bmjopen.bmj.com/content/8/12/e024262

Carmienke, S., Baumert, J., Gabrys, L., Heise, M., Frese, T., Heidemann, C., & Fink, A. (2020). Participation in structured diabetes mellitus self-management education program and association with lifestyle behavior: results from a population-based study. BMJ Open Diabetes Research and Care, 8(1), e001066. http://dx.doi.org/10.1136/bmjdrc-2019-001066

Carpenter, R., DiChiacchio, T., & Barker, K. (2019). Interventions for self-management of type 2 diabetes: An integrative review. International journal of nursing sciences, 6(1), 70-91. https://doi.org/10.1016/j.ijnss.2018.12.002

Centers for Disease Control and Prevention (2021). “Leading Causes of Death.” https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Centers for Disease Control and Prevention (CDC). (2019). “Type 2 Diabetes.” https://www.cdc.gov/diabetes/basics/type2.html#:~:text=More%20than%2034%20million%20Americans,adults%20are%20also%20developing%20it

Fajriyah, N., Firmanti, T. A., Mufidah, A., & Septiana, N. T. (2019). A Diabetes Self-Management Education/Support (DSME/S) Program in Reference to the Biological, Psychological and Social Aspects of a Patient with Type 2 Diabetes Mellitus: A Systematic Review. Jurnal Ners, 14(3), 55-64. http://doi.org/10.20473/jn.v14i3.16979

Goldenberg, R. M., Berard, L. D., Cheng, A. Y., Gilbert, J. D., Verma, S., Woo, V. C., & Yale, J. F. (2016). SGLT2 inhibitor-associated diabetic ketoacidosis: clinical review and recommendations for prevention and diagnosis. Clinical Therapeutics, 38(12), 26542664. https://doi.org/10.1016/j.clinthera.2016.11.002

Harrington, C., Carter-Templeton, H., & Appel, S. J. (2017). Diabetes self-management education and self-efficacy among African American women living with type 2 diabetes in rural primary care. Journal of Doctoral Nursing Practice, 10(1), 11-16. 10.1891/2380-9418.10.1.11

Huntriss, R., & White, H. (2016). Evaluation of a 12-week weight management group for people with type 2 diabetes and pre-diabetes in a multi-ethnic population. Journal of Diabetes Nursing, 20(2), 65-71 7p. Retrieved from http://proxy.library.vcu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,cookie,uid&db=ccm&AN=113642972&site=ehost-live&scope=site

Hurley, A. C. (1990). The health belief model: Evaluation of a diabetes scale. Diabetes Educator, 16(1), 44-48. Retrieved from http://proxy.library.vcu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,cookie,uid&db=ccm&AN=107411707&site=ehost-live&scope=site

Lawal, M., & Lawal, F. (2016). Individual versus group diabetes education: Assessing the evidence. Journal of Diabetes Nursing, 20(7), 247-250. Retrieved from http://proxy.library.vcu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,cookie,uid&db=ccm&AN=117093160&site=ehost-live&scope=site

National Committee for Quality Assurance. (2015). HEDIS report card comprehensive diabetes care. Retrieved from http://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2015-table-of-contents/diabetes-care

Sukyung, C., Panattoni, L., Chi, J., Palaniappan, L., & Chung, S. (2017). Can Secure Patient-Provider Messaging Improve Diabetes Care? Diabetes Care, 40(10), 1342-1348. doi:10.2337/dc17-0140

Self-Management Resource Center Self-Efficacy for Diabetes scale

Retrieved from https://www.selfmanagementresource.com/docs/pdfs/English_-_self-efficacy_diabetes

Criterion

Learner Score
(0, 1, 2, or 3)

Chairperson Score
(0, 1, 2, or 3)

Comments or Feedback

10 Strategic points

Topic: Provides a broad project topic area/title.

Literature Review: Lists primary points for four sections in the Literature Review: (a) Background of the problem/gap and the need for the project based on evidence from the literature; (b) Theoretical foundations (models and theories to be foundation for project); (c) Review of literature topics with at least two organizing themes and three sub-themes for each theme (d) Summary.

Minimum number of themes and sub-themes met per course requirement?

Problem Statement: Describes the problem in a single declarative sentence to address through the project based on defined gaps or needs from the literature.

Sample and Location: Identifies sample, needed sample size, location, and inclusion and exclusion criteria.

Clinical/PICOT Questions: Provides clinical/PICOT questions to all of the collected data needed to address the problem statement.

Variables: Provides variables for each project PICOT question component.

Methodology and Design: Describes the selected methodology and specific research design to address problem statements and clinical/PICOT questions.

Purpose Statement: Provides a one-sentence statement of purpose including the problem statement, methodology, design, population sample, and location.

Data Collection: Describes primary instruments and sources of data to answer research questions. Reliability and Validity of the instruments are addressed.

Data Analysis: Describes the specific data analysis approaches to be used to address clinical/PICOT questions. The statistical test(s) that will be used must be identified and must be appropriate for the level of data and the clinical/PICOT question.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

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