Part I: All Students

 The National Nurse Practitioner Symposium will hold its 12th annual conference in Keystone, Colorado, on July 21-24, 2022.  This meeting is geared to the primary and acute care nurse practitioners, and the invitation to present states a preference for clinical, innovative, research, and future-oriented topics (NPsymposium, 2022). The planned DNP project to facilitate behavioral change by implementing the 2021 ADA Guideline 5 to improve outcomes for adults with type two diabetes fits this audience. The call for abstracts closed on April 1, 2022; however, criteria are posted to view. The abstract guidelines request approximately 500 words that state a needs assessment, three learning objectives, and a summary. Research projects should include a discussion of the background, methods, results, conclusions, and references. At the same time, clinical or practice abstracts are requested to discuss evidence-based practice and references. The organization requires submitting an electronic file of the content within one month of notification of acceptance for accreditation purposes (NPsymposium, 2022).

Poster Abstract: Facilitating Behavioral Change to Improve Outcomes in Type Two Diabetes Using Smartphones

Learning Objectives: Increase provider awareness and usage of diabetes self-management education and support (DSMES) in clinical practice, empower adults with type two diabetes and obesity to align behaviors with health goals and decrease the burdens of diabetes and obesity on stakeholders and populations.

Needs Assessment: Global, National, Local

Background: Diabetes is the ninth leading cause of death globally, responsible for over one million deaths in 2017 (Khan et al., 2020). More than 37 million Americans have been diagnosed with diabetes, and nearly triple that number have prediabetes (CDC, 2022). The United States spent about $327 billion on diabetes in 2017, approximately one of every four health care dollars, and costs are rising (ADA, 2018). Diabetes Mellitus (DM) has tripled in prevalence since 2000, affecting over 466 million people worldwide (Kim et al., 2021).

Local Problem: The Diabetes Atlas mapped the age-adjusted prevalence of DM for adults in Illinois at nine percent, while estimates for Winnebago County, the clinic location, was 8.6% of adults (CDC, 2019). The practice manager and providers viewed dashboard data showing that 55% of the patients with DM are overweight or obese and have poorly controlled blood sugars.

Methods

The project team recruited a convenience sample of 20 adults aged 45-75 from existing provider panels with comorbid type two diabetes mellitus and obesity. The DNP student led a multidisciplinary team to apply the 2021 American Diabetes Association Guideline 5 to improve participants’ weight and fasting blood sugar in eight to ten weeks using the Knowledge To Action translation model and an educational plan (Graham et al., 2006). The statistical analysis plan used paired t-tests for summative evaluation after eight weeks of implementation in week ten.

Intervention

The 2021 American Diabetes Association (ADA) Guideline 5 emphasizes patient-centered diabetes self-management education and support (DSMES) and medical nutrition therapy (MNT) to promote healthy eating, regular physical activity, weight management, medication and treatment adherence, psychosocial support, and smoking cessation (ADA, 2021). The project team used smartphone technology to deliver DSMES calls and texts to empower participants to control health behaviors. The participants used food and activity logs to enhance cognitive associations between behaviors and outcomes.

Results: To be determined.

Summary with Implications for Nursing Practice

            Motivating adults with type two diabetes and obesity to engage in consistent self-care behaviors daily requires ongoing provider feedback and support (ADA, 2021). This project provides evidence that implementing DSMES per the 2021 ADA Guideline 5 using smartphone technology can decrease the burdens of diabetes at local, national, and global levels. Empowering adults with type two diabetes to be active and choose foods wisely translates to financial and social gains. This DNP project presents a scalable, feasible option as smartphone usage nears saturation in most markets (Statista, 2021).

Hello Class, in the fourth week, we will explore various ways of disseminating scholarship, including posters and professional presentations. 

            The DNP Essentials describe the expectation of continued scholarship for all DNP-prepared nurses in Essential III (AACN, 2006). Not only must the DNP-scholar translate research to practice, but nursing leaders encourage each other to share implementation findings with colleagues to aid the replication of evidence-based practice and strengthen the scientific underpinnings of the profession (Becker et al., 2018; Milner et al., 2019). Dissemination may occur via formal manuscripts, executive summaries, conference presentations, posters with or without abstracts, online venues, or submissions to professional journals (Becker et al., 2018; Kissack, 2018; Milner et al., 2019; Shafer-Astroth & Hain, 2019).

           Peer-reviewed publications offer scholars opportunities to disseminate written works to a target audience of professionals (Becker et al., 2018; Gennaro, 2019). Becker et al. (2018) remind DNP-students to acknowledge substantial faculty advisors as co-authors and found more publication success among students who received purposeful faculty guidance on scholarly writing and sequential preparation for eventual publishing of the final manuscript.

            Aspiring authors improve their chances of being published by matching the journals requested topic and content in their abstract and manuscript submissions (Becker et al., 2018; Gennaro, 2019). Gennaro (2019) recommends authors negotiate with one focused journal at a time, even as Becker et al. (2018) urge patience because manuscript reviews take months and many wait years to be published.

            Gennaro (2019) warns writers against predatory journals that charge fees and seize copyrighted control of works. Gennaro (2019) urges authors to check the journals impact factor, which reveals how often other sources cite a journal as a clue of potential legitimacy. Clarke (2019) advises digging deeper to validate journal integrity and fact-check offers, especially if promises of rapid approval, publication, or reimbursement emerge.

            Posters may be digitally formatted or hard copies, and the author may stand by, or the poster may stand alone (Kissack, 2018; Shafer-Astroth & Hain, 2019). Authors must adhere to the poster guidelines issued in the conferences call for abstracts that govern content, format, legal disclosures, copyrights, and source credits. Conference sponsors guide authors on venue arrangements and schedules for setting up and dissembling posters. Sponsors suggest that those who travel should carry flash drives or other backup files and supplies in case of technical mishaps (Kissack, 2018; Shafer-Astroth & Hain, 2019). The NP symposium used in the abstract exemplar has a vendor who prepares posters from digital files when submitted in advance with payment.

Part II: For Case Study Students

Practice Question in PICOT Format

My PICOT question is: In adults with type 2 diabetes and obesity at a primary care clinic, will implementation of the 2021 ADA Guideline 5, compared to current practice, impact fasting blood glucose and weight within 8-10 weeks? The planned project is a case study.

You are continuing to conduct your formative evaluation for intervention fidelity and provide feedback. What are you learning about project implementation?

 Project manager observations and chart audits reveal some team members are losing zeal for calling members and chart no answer without repeat attempts. This practice creates rework for the team and builds vocal frustration. The project manager will seek feedback from the disenchanted teammate on palatable ways to fulfill responsibilities without burdening others or compromising intervention integrity. The conversation will include praise for contributing to better health for our clients and acknowledgment of hard work to date. The project manager will emphasize the populations needs and end rewards while accepting personal accountability for team success.

How is the COVID-19 pandemic or other factors affecting the implementation of your practice change project?

           The pandemic has not altered implementation since the project is in week four, and most activities are remote. The team sends weekly educational and motivational texts and calls to clients using smartphones while clients complete daily food and activity logs to review weekly by phone. The project manager is in the clinic on weekdays and is accessible by phone or text when not present.

What alternate approaches could be implemented to facilitate the success of your project implementation and evaluation project phases?

 Alternate approaches exist that may aid project implementation and evaluation. Gaming or introducing an element of harmless competition with a small prize is a fun way to increase engagement. Perhaps the project manager can acknowledge winners in weekly huddles with group praise for participation. Project champions can boost the productivity of low-achievers by inspiring the motivation to excel. Improvements noted in these formative evaluations will improve summative results.

 What type of course correction may be needed? Do you need to modify your project plan? If so, what modifications would you make?

 The project is proceeding according to plans, so no course correction is needed. Team members are encouraged to complete calls Monday through Wednesday when possible. Subsequent phone appointments are set at each weekly call, and a reminder text is sent. This allows two days for the project team to recoup missed contacts. Project champions have accepted accountability to send weekly motivational texts.

What type of communication and with whom is needed for project success now? How are you engaging the stakeholders and the participants of your project?

 During daily and weekly huddles, the project manager continues project updates and feedback to clinic staff and leaders. Keeping the lines of communication open requires being accessible and approachable, so the project manager demonstrates a receptive attitude. Staying informed and shared decision-making support stakeholder engagement in project implementation.

What additional support might you need from nursing, organizational leadership, course faculty, and / your preceptor to successfully implement the evidence-based intervention? What does that support look like to you?

 Project activities are unfolding nicely despite brief lulls in motivation. The project manager and champions have bolstered the team to overcome dips in enthusiasm. Data collection from all 20 participants is on target, and staff continues to coach clients completion of daily food-activity logs. Leadership could help by reiterating the projects alignment with the organizations mission, vision, and goals in huddles (Kesten & El-Banna, 2021; Milner et al., 2019).

References

American Association of Colleges of Nursing (AACN). (2006). The Essentials of Doctoral Education for Advanced Nursing Practice.

American Diabetes Association. (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41(5), 917-928.

 American Diabetes Association (Ed.). (2021). 5. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes–2021 [Special section]. Diabetes Care, 44(S1), 553572. 

Becker, K.D., Johnson, S., Rucker, D., Finnell, D.S. (2018). Dissemination of scholarship across eight cohorts of doctor of nursing practice graduates. Journal of Clinical Nursing, 27,  e1395 e1401. 

Centers for Disease Control and Prevention. (2022). National Diabetes Statistics Report website.

Centers for Disease Control and Prevention. (2019). Diagnosed Diabetes.  

 Clarke, P. N. (2019). Open or conventional access: Integrity in the process. Nursing Science Quarterly, 32(3), 198200.

 Gennaro, S. (2019). Choosing the right journal for your manuscript. Journal of Nursing Scholarship, 51(2), 127128.

Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W. & Robinson, N. (2006). Lost in knowledge translation: Time for a Map?  Journal of Continuing Education in the Health Professions, 26 (1), 13-24.   

Kesten, K., & El-Banna, M. (2021). Strategies to reenvision Doctor of Nursing Practice projects to meet organization goals during a pandemic. The Journal of Continuing Education in Nursing, 52(2), 61-63.

Khan, M. A. B., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Kaabi, J. A. (2020). Epidemiology of type 2 diabetes–Global burden of disease and forecasted trends. Journal of Epidemiology and Global Health, 10(1), 107-111.  

Kim, Y., Lee, H., & Seo, J.M. (2021). Integrated diabetes self-management program using smartphone application: A randomized controlled trial. Western Journal of Nursing Research. 

Kissack, A. (2018). I have the abstract: How do I make it into a poster? AMWA Journal: American Medical Writers Association Journal, 33(1), 17.

Milner, K., Zonsius, M., Alexander, C., & Zellefrow, C.  (2019). Doctor of Nursing Practice project advisement: A roadmap for faculty and student success. Journal of Nursing Education, 58(12), 728-732.

NP symposium. (2022). Call for Abstracts.

 Schafer Astroth, K. & Hain, D. (2019). Disseminating scholarly work through nursing presentations. Nephrology Nursing Journal, 46(5), 545-549.

Statista. (2021). Smartphone ownership in the U.S. 2011-2021 [Fact sheet].

I NEED A COMMENT FOR THIS DISCUSSION BOARD WITH 2 PARAGRAPHS AND USE AT LEAST 3 SOURCES NO LATER THAN 5 YEARS.