10 STRATEGIC POINTS DOCUMENT 2 THE 10 STRATEGIC PO

10 STRATEGIC POINTS DOCUMENT 2
THE 10 STRATEGIC POINTS 2
SAMPLE 10 STRATEGIC POINTS
Grand Canyon University
DNP-820A: Translational Research and Evidence-Based
Practice
10 Strategic Points Document for a Quality Improvement
Project
Ten Strategic Points
The 10 Strategic Points
Title of Project
1)
Title of Project
Impact the number of depression screenings and referrals to a
child psychologist
Background

Theoretical Foundation
Literature Synthesis
Practice Change Recommendation
2)
Background to Chosen Evidence-Based
Intervention:
List the primary points for six sections.
i) Background of the practice problem/gap at the project site
One of the primary causes of disability worldwide, depression
affects a sizable percentage of the population. Persistent
feelings of sadness and guilt, changes in sleeping patterns
(insomnia or oversleeping), changes in appetite, decreased
mental and physical energy, unusual irritability, inability to
enjoy once-enjoyed activities, difficulty working, and thoughts
of death or suicide are all symptoms that can be associated with
any type of depressive disorder. These "down" symptoms alone
may indicate a unipolar depressive disorder like dysthymia or
severe depression if they are present. A person may be
diagnosed with bipolar illness if they experience alternating
spells of depression and euphoria. Adolescents and young adults
increasingly have difficulties with their mental health (Poppen
et al., 2016). An individual's mental health is something only
they can fully comprehend, making it difficult for friends and
loved ones to spot warning signs in time to intervene. Juvenile
and young adult suicide is a major problem in today's world. A
lack of life experiences, self-confidence, and faith in one's own
skills contribute to the suicides of many young individuals.
ii) Significance of the practice problem/gap at the project site
Mental illness has been a problem that is affected the
population for a long period and worryingly young people and
adolescents are experiencing many effects that lead to some
committing suicide. The stress that today's youth encounter
nowadays is the most significant of all these issues, especially
the pressure they receive based on their academic expectations
and poor communication about their troubles to their parents.
There is also a gap in the schools in terms of students receiving

counseling services because there are limited professional
counselors that attend to student needs. Despite the fact that
psychologists claim stress could be caused by anything, many
young people find the rapid pace of modern life to be a
significant source of anxiety. Many young individuals are
inspired to take their own lives by the media's glorified
depiction of suicide (Poppen et al., 2016). The reality that
suicide is always fatal seems to be lost on many young people.
Young people, in other words, consider suicide an option for
self-expression or as a means of making up for past misdeeds.
iii) Theoretical Foundations (choose one nursing theory and one
evidence-based change model to be the foundation for the
project):
The most likely reasons for people to take their own lives are
outlined in Emile Durkheim's theory of suicide. According to
the theory, a person's lack of social integration may be a
contributing factor in their decision to take their own life after
experiencing chronic depression. It is possible that individuals
do not have adequate psychosocial assistance to help them deal
with the difficulties of life (Poppen et al., 2016). There is
limited psychological assistance in schools making it a
significant cause of the burden of psychological issues that
leads to chronic depression. These individuals have weak egos
because they lack sufficient social networks in their immediate
environment. It is society's fault, according to Durkheim,
because the regulations that restrict people's actions are so lax.
He is of the opinion that individuals' actions are influenced by
social problems such as the economic crisis, pressure from
academic work for high school adolescents, and particularly
when such people are unable to cope with their depression.
Additionally, the notion indicates that an individual may choose
to end their own life if they have the perception that the
regulations that are in place restrict their freedom.
Evidence-Based Change Model
A wide number of approaches can be taken to bring about
change in healthcare organizations. The data, assessment, and

plan (DAP) project's activities, which include community and
adolescent education, community presentations to improve
awareness of depression, and teaching positive coping
strategies, will be efficiently implemented with the use of the
PDSA model's four steps: plan, do study, and act. During the
"plan" phase of the DAP program, a group consisting of school
nurses, parents, instructors, and students themselves will serve
as the program's leaders. After the planning stage comes to the
"Do" stage, which is where the actual execution of the program
takes place. The DAP program will include a variety of
components, including public education, the promotion of
healthy emotional expression among adolescents through the
medium of painting, and the instruction of coping skills
(Poppen et al., 2016). The "Study" step is where you'll be doing
any kind of analysis or assessment of the program. A few of the
factors that are taken into consideration are the return on
investment, any necessary adjustments, and the possibility of
unfavorable repercussions. The final phase of the PDSA process
is referred to as the "Act." It includes conducting an in-depth
analysis of the project's goals and results.
iv) Create an annotated bibliography using the "Preparing
Annotated Bibliographies (APA 7th)" located in the Student
Success Center. https://www.gcumedia.com/lms-
resources/student-success-center-content/documents/writing-
center/preparing-annotated-bibliographies-apa7-mla8-
turabian9.pdf utilizing the five (5) original research articles that
support the evidence-based intervention. This will be the
foundation of the Literature Synthesis you will have to do in
DNP-820A.
Kroning, M., & Kroning, K. (2016). Teen Depression and
Suicide: A Silent Crisis. Journal of Christian Nursing, 33(2),
78.
https://doi.org/10.1097/CNJ.0000000000000254
Kroning et al. discuss the hidden epidemic of adolescent
depression. They discovered that over 11% of all teenagers and

nearly a third of all high school students suffer from depression.
About one-fifth of high school pupils (about 17%) have
seriously considered suicide. Intriguingly, adolescent
depression is rarely given the attention it deserves. The article
describes the events leading up to the death of a 17-year-old girl
and discusses the warning indicators of depression that could
have been observed. Teen depression is a major public health
problem. Many adults have witnessed kids' melancholy and
incorrectly assumed it was due to hormonal changes, defiance,
or general adolescent irritability. When comparing causes of
mortality among people aged 15–24, suicide is by far the most
common worldwide. The article provides a detailed plan that
can save the life of a depressed person and keep them from even
considering suicide.
Best, P., Manktelow, R., & Taylor, B. (2014). Online
communication, social media, and adolescent wellbeing: A
systematic narrative review.
Children and Youth Services Review,
41, 27-36
Researchers in this study used a narrative synthesis method and
a valued appraisal instrument to read the articles and analyze
the findings. The research aimed to answer the following
question: "What are the positive and negative consequences of
social media among youth?" (Best et al., 2014). Further, this
study illustrates the beneficial and bad effects of social media
use on adolescents' mental health; this outcome aids me in my
investigation of the relationship between adolescent use of the
internet and their physical and mental well-being. Evidence
from Best et al. (2014) shows that social media can have both
beneficial and negative effects on adolescents' mental health;
however, the authors also suggest that further research is
needed to strengthen the connection between social media and
adolescents' psychological well-being.
O'Reilly, M., Dogra, N., Hughes, J., Reilly, P., George, R., &
Whiteman, N. (2018). Potential of social media in promoting

mental health in adolescents.
Health Promotion International, 1-11.
The study details the examination of three primary topics: the
role of social media in the mental health of teenagers, the
benefits and problems of social media and mental health, and
the future directions for research on these topics. Further, this
lends credence to the idea that social media can have both
beneficial and detrimental effects on young people's mental
health. Finally, the study does a fantastic job of disaggregating
responses by gender and age, resulting in a wide range of
perspectives on the potential effects of social media. The
concepts of social media opinion, mental health, and views for
the future of social media in the context of health informed the
design of the focus group.
Wang, X., Cai, L., Qian, J., & Peng, J. (2014). Social support
moderates stress effects on depression. International Journal of
Mental Health Systems, 8(1), 41. https://doi.org/10.1186/1752-
4458-8-41
The paper explores how social support plays a role in mitigating
depression and other stress-related outcomes. A survey of
college students was administered to assess their levels of
social support, stress, and depressive symptoms. In a regression
study, it was discovered that social support mitigates the
association between depression and stress. Undergraduate
students who had high-stress levels were discovered to be
having depression. The students who reported having social
support from faculty and peers were in a different situation.
Anxiety manifests itself mentally when the needs of the spirit
exceed the capabilities of the body. It's very uncommon for this
to lead to additional feelings of negativity, despair, and anxiety,
all of which can stunt a person's ability to mature and flourish
as a person. Individual and environmental variables both play a
role in the development of depression.
Albert, P. R. (2015). Why is depression more prevalent in
women? Journal of Psychiatry & Neuroscience: JPN, 40(4),

219–221.
https://doi.org/10.1503/jpn.150205
The article discusses how common depression is among women.
Major depressive disorder is a serious health problem that
affects many people. It is estimated that in 2010, depression
disorders were the second-leading cause of burdens for
Canadians with disabilities, after mobility impairments. When
people are depressed, it often results in their own death by
means of suicide or a stroke. Depression ranks as the third
leading cause of death around the world because of all these
deaths. Education and income, maltreatment, and other
socioeconomic issues all have a role in exacerbating women's
already high suicide incidence.
v) Summary of the findings written in this section.
The adolescents that suffer from depression are contributed by
multiple factors that include social issues, academics, lack of
support, and the influence of social media. The limited
resources for addressing mental health in high school result in
cases of chronic depression. There is a need for screening to
assist adolescent students in the preliminary stages and avoid
cases of depression.
Problem Statement
3)
Problem Statement:
Depression is a huge problem among adolescents in high school
and prior screening through schools having enough counsellors
and creating awareness help in mitigating the risks and
consequences.
PICOT to Evidence-Based Question
4)
PICOT Question Converts to Evidence-Based
Question:
The purpose of this quantitative, quasi-experimental quality
improvement project is to determine if or to what degree the
translation of research by Anand et al. utilizing the Patient

Health Questionnaire-9 (PHQ-9) will impact the number of
depression screenings and referrals to a child psychologist when
compared to current practice among adolescents at a high school
setting in urban Texas over eight weeks.
Sample
Setting
Location
Inclusion and Exclusion Criteria
5)
Sample, Setting, Location
The sample size targeted is 15 participants and the study setting
is the urban area of Texas. High school adolescents and
counselors are the target participants.
Define Variables
6)
Define Variables:
i) Independent Variable (Intervention): Therapy/counseling and
having enough counsellors.
ii) Dependent Variable (Measurable patient outcome):
Depression
Project Design
7)
Project Design:
However, research findings do not have to be immediately
integrated into clinical practice, the fundamental purpose of
quality improvement programs is to improve patient care. To
identify a problem, research must be undertaken, and quality
enhancement entails gathering evidence that can be used to
better the topic of interest.
Purpose Statement
8)
Purpose Statement:
The purpose of this quality improvement project is to determine
if the implementation of therapy/counseling intervention would
impact the mental health well-being among high school
adolescents. The project was piloted over eight weeks in an

urban setting within Texas state.
Data Collection Approach
9)
Data Collection Approach:
To gather and analyze demographic data, I plan to use an Excel
spreadsheet. By consulting with healthcare professionals and
conducting the survey with 15 participants, I will be able to
collect valid and trustworthy data on patient outcomes. To
ensure that the collected data can be replicated, the survey
instrument employs a standardized, organized format. In the
realm of data collecting and analysis, spreadsheets are widely
regarded as among the most efficient and trustworthy tools
available.
i) 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.
I would first seek the approvals from necessary authorities and
also get the consent from the target participants that is the
counsellors and high school adolescents. The participants are 15
in number from Urban Texas.
High school adolescent patients in mental health care are given
an evaluation questionnaire to fill out, with two weeks allotted
to finish the process. The questionnaire itself takes only a few
minutes to complete. To acquire this data, we have them fill out
a questionnaire and record their responses in a spreadsheet. A
copy of the encrypted data is subsequently uploaded to a remote
server.
ii) Discuss potential ethical issues pertaining to your project.
Ethical Considerations in Human Research Protection (i.e.,
confidentiality vs anonymity of the data, informed consent, and
potential conflict of interest.)
Participants are needed to sign the informed consent form as
soon as they agree to take part in the study, demonstrating their
willingness to allow the data to be shared. The participants'
anonymity is protected by the confidentiality guarantees
inherent in the informed consent process. The participant has

the moral right to expect that their date would be kept private
and discreet. There should be no potential conflict of interest
between the researcher and the participant.
iii) Discuss how you will adhere to the principles of the
Belmont Report (respect, justice, and beneficence) in the
project design, sampling procedures, within the theoretical
framework, clinical problem, and clinical questions.
I would analyze the Belmont report and make sure that all the
requirements are adhered to in the research study.
Data Analysis Approach
10)
Data Analysis Approach:
Using a descriptive statistical method and demographic
analysis, I would examine the provided descriptive data and
demographic information. If I were to analyze the quantifiable
patient outcomes, I would use the chi-square test. In this case, I
would resort to the techniques employed by statisticians. A
possible source of error in the data is that respondents provided
false information, especially about demography. To deal with
this difficulty, we can establish a range within which each given
piece of data should lie to ensure that our results can be
reproduced.
References
Albert, P. R. (2015). Why is depression more prevalent in
women? Journal of Psychiatry & Neuroscience: JPN, 40(4),
219–221.
https://doi.org/10.1503/jpn.150205
Best, P., Manktelow, R., & Taylor, B. (2014). Online
communication, social media, and adolescent wellbeing: A
systematic narrative review.
Children and Youth Services Review,
41, 27-36
Kroning, M., & Kroning, K. (2016). Teen Depression and
Suicide: A Silent Crisis. Journal of Christian Nursing, 33(2),
78.

https://doi.org/10.1097/CNJ.0000000000000254
O'Reilly, M., Dogra, N., Hughes, J., Reilly, P., George, R., &
Whiteman, N. (2018). Potential of social media in promoting
mental health in adolescents.
Health Promotion International, 1-11.
Poppen, M., Sinclair, J., Hirano, K., Lindstrom, L., & Unruh, D.
(2016). Perceptions of Mental Health Concerns for Secondary
Students with Disabilities during Transition to Adulthood.
Education And Treatment Of Children,
39(2), 221-246.
https://doi.org/10.1353/etc.2016.0008
Wang, X., Cai, L., Qian, J., & Peng, J. (2014). Social support
moderates stress effects on depression. International Journal of
Mental Health Systems, 8(1), 41. https://doi.org/10.1186/1752-
4458-8-41
The 10 Strategic Points for the Prospectus, Proposal, and Direct
Practice Improvement Project
Introduction
In the Prospectus, Proposal, and Direct Practice

Improvement Project, there are
10 key or strategic points that need to be
clear, simple, correct, and aligned to ensure the project
is
doable, valuable, and credible. These points, which
provide a guide or vision for the project, are present in almost
any project. The 10 Strategic Points are defined within this
document and a template provided. The ten strategic points are
developed in a table format, as noted below.
The Process for Defining the 10 Strategic Points
The order of the 10 Strategic points listed below reflects
the order in which the learner completes the work product. The
first five strategic points focus primarily on defining the
purpose or focus for the project based on a clearly defined need
or gap from the literature as well as the learner’s passion and
specialty area focus. First, learners identify a broad topic area
to investigate for their Direct Practice Improvement (DPI)
Project. Second, learners complete a review of the literature to
define the need or gap to be addressed, the theories and models
that will provide a foundation for the project, related themes
that are needed to demonstrate the learner's expertise in the
field and to define the key strategic points behind the learner's
proposed project. Third, the learners develop a clear, simple,
one-sentence problem statement that defines the problem or gap
that will be addressed by the DPI project. Fourth, learners
identify a potential population from which sample data will be
collected for the project. Fifth, learners develop the
clinical/PICOT question(s) that will define the data needed to
address the problem statement.
Based on the first five strategic points above, learners next
define the key aspects of the project methodology through the
last five strategic points. The sixth point describes the
independent and dependent variables. Seventh, learners
determine if the project will be a qualitative, quantitative, or
mixed methodology. Due to the evidence-based nature and

feasibility of the DPI project requirement, most DPI projects
will be utilizing a quantitative method because learners are not
creating new evidence like that determined through qualitative
or mixed methods.
For the eighth strategic point, learners develop a purpose
statement by integrating the problem statement, methodology,
design, sample, and location. Ninth, learners identify the data
they will need to collect to address the clinical questions or
PICOT components. This includes the variables, level of
measurement, and method used to collect the data (e.g.,
interviews, focus groups, observations, tested and validated
instruments or surveys, databases, public media, etc.). Tenth
and last, learners identify the appropriate data analysis, based
on their project design and variables, which will be used to
answer the clinical questions and address the problem
statement.
Criteria for Evaluating the 10 Strategic Points: Clear, Simple,
Correct, and Aligned
When developing a project, it is important to define the 10
Strategic points, so they are
simple,
clear, and
correct in order to ensure that anyone who reviews them
will easily understand them. It is important to
alignall of the 10 Strategic points to ensure it will be
possible to conduct and complete the project. The problem
statement must be derived from the literature or practice
problem. The clinical questions must be used to specify the
variables or data to be collected to answer the problem
statement. The methodology and design must be appropriate for
the problem statement, clinical, and PICOT question(s). The
data collection and data analysis must provide the information
to answer the PICOT questions.
Developing the 10 Strategic Points document begins in DNP-
815 begins as a two- or three-page document that can help

ensure clarity, simplicity, correctness, and alignment of each of
these 10 key or Strategic points in the prospectus, proposal, and
Direct Practice Improvement Project. Developing these 10
Strategic points using this easy-to-use use template ensures the
10 Strategic points will always be worded the same throughout
the prospectus, proposal, and Direct Practice Improvement
Project manuscript. Please see the table below regarding the
development of the citation requirements expected per course.
Course
# of Themes
# of Sub-themes
Minimal number of articles
DNP-815
Minimum of 2 themes (can have more)
Minimum of 3 per theme
Begin collecting evidence synthesis of the sub-themes (3
articles per sub-theme)
· If you have the scholarly referenced article, you may begin
adding them now)
DNP-820
Need a minimum of one, scholarly referenced article per sub-
theme (at least 6)
DNP-830
Need a minimum of two, scholarly referenced articles per sub-
theme (at least 12)
DNP-835
Need a minimum of three, scholarly referenced articles per sub-
theme (at least 18)
Value of the 10 Strategic Points Document
The 10 Strategic Points document can be used for

communicating and aligning key stakeholders for the Direct
Practice Improvement Project. This document can be used to
obtain agreement between the learner and the chair regarding
the initial focus and approach for the project. The document can
be used to review the proposed project with the people or
organizations from whom learners need to gain permission to
conduct their project, a critical step required before learners can
develop their proposal. The document also proves useful for
communicating the Direct Practice Improvement Project focus
when attracting a Content Expert, as well as for reviewing the
proposal with the Direct Practice Improvement Project
committee and the AQR reviewers. Learners may choose to
consult methodologists, statisticians, and editors in the process
of developing the final manuscript from the 10 Strategic points.
Examples of the 10 Strategic Points Document
It is important that the 10 Strategic points are clear, concise,
doable, and aligned throughout the prospectus, proposal, and
Direct Practice Improvement Project. Provided below is an
example of a completed 10 Strategic Points document for a
quantitative project. Following the example, a blank 10
Strategic Points Table template is provided for learners to use
when developing their own 10 Strategic Point documents.
Example: 10 Strategic Points Document for a Quantitative
Project
Broad Topic Area
1.
Broad Topic Area:
Hint: What would I title my project?
Literature Review
2.
Literature Review:
List primary points for four sections in the Literature Review:
Background of the problem/gap, theoretical foundations (models
and theories to be the foundation for the project); review of

literature topics with the key theme for each one; and summary.
a.
Background of the Problem/Gap:
· Rural ambulatory clinics have had to reorganize their
management structures to enhance reimbursement.
· Access to appropriate health services for rural Americans
needs to be improved in areas where specialists are not
available (Schoenberg, 2012).
· Telehealth nursing services can be provided through rural
health clinics to support specialty clinics (Schoenberg, 2012).
· Approximately 200 telemedicine networks have been
established nationwide. (American Telemedicine Association,
2017)
b.
Theoretical Foundations (models and
theories to be the foundation for the project):
· The Greenhalgh’s Dissemination of Innovations model
(Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidau, 2005)
can be used to implement rural telehealth services for rural
Americans.
· The D&M Information System Success model (DeLone
&McLean, 2003) is a framework to conceptualize and
operationalize information system success.
· Path constitution theory combines two contrasting
perspectives on technology, path dependence, and path creation
(Singh, Mathiassen, & Mishra, 2015).
c.
Review of Literature Topics with Key
Themes and Subthemes
Rural Telehealth Services: (Theme example)
· Rural telehealth can improve care in burn patients
(McWilliams, Hendricks, Twigg, Wood, & Giles, 2016);
smoking cessation (Carlson, Lounsberry, Maciejewski, Wright,
Collacutt, & Taenzer, 2011), psychotherapy (Gonzales &
Brossart, 2015); cancer education (Doorenbos et al., 2011);

diabetes (Holloway, Coon, Kersten, & Clemins, 2011).
Population Specific Telehealth Services:
· Community-based telehealth: Home-based telehealth can
enhance older adults’ access to care and facilitate patient-
provider collaboration, which may, in turn, improve patient
self-management (Hsieh, Tsai, Chic, & Lin, 2015).
· Chronically ill: Disease management needs of chronically ill
patients include prescription refills, medication and symptom
management, lab results, and patient education (Vinson,
McCallum, Thornlow, & Champagne, 2011).
· Rural Native American telehealth: Telehealth can improve
health disparities in Native American communities (Kruse,
Bouffard, Dougherty, & Parro, 2016).
· Diabetes education and management: Telehealth education
improves glycemic control (Barker, Mallow, Theeke, &
Schwertfeger, 2016).
· Mental health emergencies can be managed effectively through
telehealth services (Saurman et al., 2011).
Settings:
· Rural health clinic/hospital (Carlson et al., 2011); Doorenbos
et al., 2011; Gonzales & Brossart, 2015; Holloway et al., 2011).
· Home-based (Demiris et al., 2103).
· Community center (Demiris et al., 2103).
· Library (Demiris et al., 2103).
· Smartphone, computer-based (Forchuk et al., 2016).
Certifications:
· National Committee for Quality Assurance (n.d). Disease
Management Accreditation. Retrieved from
http://www.ncqa.org/programs/accreditation/disease-
management-dm
· American Association of Critical-Care Nurses (n.d.). CCRN-E:
Certification for Tele-ICU Nurses. Retrieved from
https://www.aacn.org/certification?tab=First-
Time%20Certification
· Acute stroke ready designation (Slivinski, Johes, Whitehead,
& Hooper, 2017).

Network Systems:
· American Telemedicine Association: approximately 200
telemedicine networks have been established nationwide
(Frederick, 2013).
· Tablet PC Enabled Body Sensor System: a continuous real-
time collection of physiological parameters (Panicker, Kumar,
2016).
d.
Summary
· Gap/Problem: There is a need to implement evidence-based
methods of improving the health outcomes of rural residents
through the use of telehealth.
· Prior studies: Prior studies show that telehealth improves
patient outcomes in diverse settings, including rural areas.
· Quantitative application: Sources of data exist to collect
numerical data on the rate of follow-up with the primary care
provider in rural areas.
· Significance: Improving the rate of follow-up with the primary
care provider will improve the health outcomes of rural
residents.
Problem Statement
3.
Problem Statement:
Describe the variables/groups to project, in one sentence.
A well-written problem statement begins with the big picture of
the issue (
macro) and works to the small, narrower, and
more specific problem (
micro). It clearly communicates the
significance, magnitude, and importance of the problem and
transitions into the Purpose of the Project with a declarative
statement such as: “It is not known if and to what
degree/extent...” or “It is not known how/why and….”

It was not known if or to what degree the implementation of
__________________would impact ______________ when
compared to _______________ among ___________
(population).
While the literature indicates that telehealth is an important
emerging technology for rural patient access, it is unknown if
the implementation of telehealth impacts the rate of patient
follow up for patients living in a rural area.
Clinical or
PICOT Questions
4.
PICOT Questions or Clinical Question:
(P) Among adult patients in a rural care setting,
(I) how does the implementation of a
telehealth program
(C) compare to traditional commute-for-care
(
O) impact rate of follow-up with the primary
care provider (
T) over a period of four weeks?
Clinical Question:
To what degree does the implementation of _______________
(intervention) impacts __________________ (what) when
compared to _____________ among _____________
(population) patients in a ______ (setting) in _______ (state)?
Sample
5.
Sample (and Location):
Identify sample, needed sample size, and location (project
phenomena with small numbers and variables/groups with large
numbers).
a. Location: Arizona
b. Population (Participants)

c. Sample: 40 participants include a power analysis if
appropriate.
d.
Inclusion Criteria
· Who can participate?
e.
Exclusion Criteria
· Who cannot participate
Define Variables
6.
Define Variables:
a.
Independent Variable (Intervention):
Telehealth program.
b.
Dependent Variable: Follow-up rate with the
primary care provider.
Methodology and Design
7.
Methodology and Design:
Name the selected methodology and specific design to address
the problem statement and clinical questions:
This project will use a quantitative methodology with a quasi-
experimental design.
Purpose Statement
8.
Purpose Statement:
Provide one sentence statement of purpose including the
problem statement, sample, methodology, and design:
The purpose of this quantitative, quasi-experimental project was
to determine if or to what degree the implementation of
_________________ (intervention) would impact
______________(what) when compared to

_______________________ among ___________(population)
in a ________ (setting ie: primary care clinic, ER, OR) in
________ (state) over _____ time.
9.
Describe primary instruments that will be used to answer the
clinical question. Think about your step by step data collection
approach from start to finish.
10.
Descriptive statistics will describe the sample characteristics
and variable results.
Explain the test used to obtain the statistical analysis and
results of the measurable patient outcome.
What method will be used to justify the sample size?
10 Strategic Points Table
(Use this table to complete the 10 Strategic Points document for
your project.)
Broad Topic Area
1.
Broad Topic Area/Title of Project:
Literature Review
2.
Literature Review:
a.
Background of the Problem/Gap:
b.
Theoretical Foundations (models and
theories to be foundation for the project):

c.
Review of Literature with Key Organizing
Themes and Sub-themes (Identify at least two themes, with
three sub-themes per theme)
Theme 1 (placeholder only; name theme):
Sub-theme 1 Grouped findings related to Theme 1
Sub-theme 2
Sub-theme 3
d.
Summary
· Gap/Problem:
· Prior studies:
· Quantitative application:
Significance:
Problem Statement
3.
Problem Statement:
It was not known if or to what degree the implementation of
__________________would impact ______________ when
compared to _______________ among ___________
(population).
Clinical/
PICOT Questions
4.
Clinical/PICOT Questions:
To what degree does the implementation of _______________
(intervention) impacts __________________ (what) when
compared to _____________ among _____________
(population) patients in a ______ (setting) in _______ (state)
over four-weeks?
Sample
5.
Sample (and Location):

a. Location: Urban/Rural (State)
b. Population (Participants)
c. Sample: Specify the sample size desired and perform a
power analysis if appropriate.
d.
Inclusion Criteria
· Who can participate?
e.
Exclusion Criteria
· Who cannot participate?
Define Variables
6.
Define Variables and Level of Measurement:
a.
Independent Variable (Intervention):
b.
Dependent Variable:
Methodology and Design
Methodology and Design:
Purpose Statement
Purpose Statement:
The purpose of this quantitative, quasi-experimental project was
to determine if or to what degree the implementation of
_________________ (intervention) would impact
______________(what) when compared to
_______________________ among ___________(population)
in a ________ (setting ie: primary care clinic, ER, OR) in
________ (state) ___ time.

References
APA formatted sources.
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).
© 2020. Grand Canyon University. All Rights Reserved.
6
image1.jpeg
10 Strategic Points Documents for Quality Improvement
Project Comment by Ginger King: Your spacing is off. Please
follow the template.

JAMES Comment by Ginger King: Please use the template.
Nursing Department, Grand Canyon University
DNP 835A: 10 Strategic Points Document for a Quality
Improvement Project
10 Strategic Points Document for a Quality Improvement
Project
Title of Project
1)
Title of Project
Using continuous glucose monitoring to manage adult patients
with type II diabetesComment by Ginger King: Please be sure
your title is indicative of what your project is. DO not use slang
such as "manage" adult patients.
Background
Theoretical Foundation
Literature Synthesis
Practice Change Recommendation
2)
Background to Chosen Evidence-Based
Intervention:
List the primary points for six sections. Comment by Ginger
King: Why is this page cutoff? Please fix your formatting
errors.

i) Background of the practice problem/gap at the project site
Several chronic conditions negatively impact the lives of
patients. Among such conditions is diabetes. Diabetes causes
numerous other complications, such as kidney disease, heart
disease, and stroke (Skinner et al., 2020). The other concern
about diabetes is that it affects millions of people, making them
unable to live normal lives. The implication is that various
researchers and stakeholders have, in the past and present, been
pursuing effective ways or strategies to better manage diabetes.
Non-the less, diabetes is still among the most prevalent chronic
conditions (Khan et al., 2019). According to Khan et al. (2019),
the diabetes global prevalence among the adult population is as
high as 9%. The interventions currently in use among patients
living with diabetes majorly focus on helping patients attain
better healthcare outcomes, such as better glycemic control and
keeping in check the risky lifestyle behaviors that may hinder
the control and management of the condition (Maiorino et
al.,2020). Even though effective interventions should be
applied, the management strategies used in the practice site
have not achieved the desired results as most of the patients fail
to achieve the required HbA1c levels hence poor health
outcomes. Indeed, uncontrolled levels of HbA1c have been
connected to myocardial infarction and stroke disease (Azhar et
al.,2022). Therefore, there is a need to use more effective
strategies to manage the condition. Comment by Ginger King:
This is your PICOT:
Among adult patients with type 2 diabetes in an outpatient
clinic, will the translation of Beck et al.'s research on
continuous glucose monitoring increase the rate of practitioners
ordering continuous glucose monitoring impact HgbA1C
compared to current practice in 12 weeks?
Therefore, your problem it sounds like is the lack of prescribing
from the NPs for CGM…..correct? If this is the case, this is
what you need to be discussing. I don’t think anyone would
disagree with you about the health risks for patients with

diabetes. However, you should be discussing what the research
is showing regarding CGM compared to traditional prescribing
methodology. How frequently is it being prescribed now? What
are the parameters? Comment by Ginger King: Please continue
to work on this. Please incorporate prior feedback. What is the
problem? Why is this something we should care about? Start
broad and then narrow to the project site. Include citations less
than 7 years. Do this succinctly and concisely using scholarly
writing.
ii) Significance of the practice problem/gap at the project site
As earlier highlighted, diabetes causes other undesirable
problems apart from making those who live with it spend more
money on treatment and management (Bommer et al., 2018).
Therefore, the need to control and manage the disease has
attracted the attention of several stakeholders, including nurses,
doctors, and other researchers in the medical and nursing fields.
There have been advancements in the management of diabetes,
largely due to the new innovative technologies used in
diagnostics and treatment (Haque et al., 2021). However, the
annual number of people who get the disease still runs into
millions. In addition, the prevalence rates have been rising in
recent years, while several others die annually due to diabetes
(Khan et al., 2019). The negative impacts caused by the disease
can reduce through using nursing interventions based on the
current technology and technological applications such as
continuous glucose monitoring. The intervention can dictate the
rate of practitioners ordering Continuous glucose monitoring as
directed by the results to further improve outcomes. The
implication is that, in the event that continuous glucose
monitoring leads to improvement in the expected HbA1c levels,
then the practitioners at the project site are more likely to
increase the rates of the ordering of continuous glucose
monitoring for better outcomes (Root et al., 2022). This will be
significant to the project site as it will indicate a change in
diabetes management practices for better patient outcomes
Comment by Ginger King: Please revise this section so

that it addresses the feedback previously provided.
Significance of the practice problem: Why is this important?
This should be addressed here with citations and how is this
significant for the project site? You are building the case as to
why this project should be implemented.
iii) Theoretical Foundations (choose one nursing theory and one
evidence-based change model to be the foundation for the
project):
Nursing theories are key in implementing nursing interventions
as they offer a framework upon which to base the aspects of
interventions (Brandão et al., 2019). Therefore, this project will
use Dorothea Orem's self-care theory. The theory is mainly
defined as the act of helping others by offering and maintaining
self-care to maintain and improve human functioning at the
home level effectiveness. The theory states that an individual
has an ability to perform self-care as "the practice of activities
that individuals initiate and perform on their behalf to maintain
life, health, and well-being (Butts & Rich, 2018). Dorothea’s
theory has three interconnected sub-theories; the theory of self-
care, the self-care deficit theory, and the theory of nursing
systems (Orem & Calnan, 1972). Dorothea Orem's theory is one
of the nursing theories widely applied in nursing quality
improvement and change initiatives. This theory will be used in
guiding the DNP project on diabetes management and
prevention. Self-care is key in diabetes management. Therefore,
the underpinnings will be key in helping the individuals
evaluate themselves and choose the necessary actions required
to attend to the needs of self-care by accomplishing the actions
(Butts & Rich, 2018), which in this case is continuous glucose
monitoring. Therefore, patients can be motivated to follow the
interventions for better care. The theory underlines that self-
care is learned and is more natural to adults. Therefore, it will
guide the project toward promoting self-care for healthcare,
well-being, and self-maintenance among the identified patients
living with diabetes.
The theory is also appropriate for the management of diabetes

as it also focuses on the possible deficits that the caregivers or
the patients may be having in terms of appropriate resources
and information key to better management (Orem & Calnan,
1972). In addition, the theory also highlights the inability of
patients to take care of themselves, hence the need for support.
The patients will, therefore, be able to lower the chances of
emergency room visits by taking instructions on the use of
continuous glucose monitoring. The use of continuous glucose
monitoring also focuses on self-care as the patients will be
required to use the monitors, and the existence of a deficit will
be a springboard to help the caregivers to collaborate and offer
the best to achieve the set goals. Another aspect of the theory is
the application of innovative and creative ideas. Such ideas are
key if the evidence is to be used to positively impact patient
outcomes. As such, upon the improvement of patient outcomes
through glucose monitoring, the impact and the next set of goals
will be communicated to the care teams to help facilitate the
new practice with the major focus of improving patient patients.
Comment by Ginger King: See prior feedback. The
theoretical foundations models and theories you chose should
related to and support the problem statement or project topic.
The theory states …….. (CITE)
There are four components…… (CITE)
This theory helps the project by LINKING…. (CITE)
Lewin's change model will provide the theoretical foundation
and constructs in the change practice by addressing behaviors,
fears, anxieties, and attitudes and reducing stakeholder worries.
Kurt Lewin's change theory comprises three stages, unfreezing,
change, and refreezing (Lewin, 1947); (Hussain et al.,2018).
The theory asserts that there are two types of forces, the driving
and restraining forces pushing in the direction that makes
change happen and the direction that hinders the change,
respectively. A change only occurs when the driving forces
override the restraining forces (Cummings et al., 2016). In the
unfreezing stage, a method is proposed to help individuals move
from old behavior patterns and accept change. The change or

moving stage entails changing behavior, feeling, and thoughts.
The final step, refreezing, entails making the new change as a
new habit or standard (Lewin, 1947). When applying the change
model, the unfreezing stage will involve asserting the need for
patients to have improved HbA1c levels hence the need for
more effective intervention. Therefore, patients and nurses will
be made to appreciate the need for change. During this stage,
the nurses involved will ensure that the patients see the urgency
of the need to have well-controlled HbA1c levels. The second
step will involve implementing the proposed intervention for
better diabetes outcomes. Support is offered to nurses who offer
the intervention to patients, and the patients are encouraged to
adhere to the intervention requirements. At this stage, the
intervention is rolled out, and the patients are encouraged to use
continuous glucose monitoring. The final step will involve
making the intervention part of standard practice to ensure that
patients have better outcomes. Therefore, nurses will be advised
to apply the intervention to patients with diabetes for better
diabetes outcomes. Besides, ordering continuous glucose
monitoring by the practitioners will be expected to be the
standard part of the diabetes management practices at the
practice center.Comment by Ginger King: Please be sure you
are using a theory and not a model. Fix this. Comment by
Ginger King: How so? This doesn't fit here. Comment by
Ginger King: How many NPs are at this clinic? Comment by
Ginger King: Please continue to work on this section. See prior
feedback.
iv) Annotated bibliography.
Beck, R. W., Riddlesworth, T. D., Ruedy, K., Ahmann, A.,
Haller, S., Kruger, D., ... & DIAMOND Study Group. (2017).
Continuous glucose monitoring versus usual care in patients
with type 2 diabetes receiving multiple daily insulin injections:
a randomized trial.
Annals of Internal Medicine,
167(6), 365–374. DOI: 10.7326/M16-2855.

In this study by Beck et al. (2017), the primary aim was
to determine the effectiveness of continuous glucose monitoring
in adults with type 2 diabetes who were getting insulin
injections. By employing a randomized controlled trial as the
research design, these researchers recruited one hundred and
fifty-eight patients with type 2 diabetes. Seventy-nine patients
were randomized into the usual care group, with the remaining
half recruited into the intervention group. While the continuous
glucose monitoring group used a Dexcom G4 platinum
continuous monitoring system to monitor their glucose
concentrations, the control groups engaged in glucose self-
monitoring. The mean HbA1c levels went down to 7.7 % and
8.0% in the continuous glucose monitoring group and control
group, respectively (adjusted difference in mean change, −0.3%
[95% CI, −0.5% to 0.0%]; p = 0.022), showing that the
intervention was efficacious. This study implied that the
statistically significant improvement in the HbA1c levels among
the patients in the intervention groups results when continuous
glucose monitoring is used indicates that continuous glucose
monitoring is key in improving diabetes outcomes such as
HbA1c levels. Comment by Ginger King: This sentence doesn't
make sense.
Gilbert, T. R., Noar, A., Blalock, O., & Polonsky, W. H. (2021).
Change in hemoglobin A1c and quality of life with real-time
continuous glucose monitoring use by people with insulin-
treated diabetes in the landmark study.
Diabetes Technology & Therapeutics,
23(S1), S-35.
https://doi.org/10.1089/dia.2020.0666
The study by Gilbert et al. (2021) aimed to assess the
changes in HbA1c levels upon using a continuous glucose
monitoring system. The recruited patients were two hundred and
forty-eight, with sixty having type 2 diabetes. The participants
were requested to upload their point-of-care HbA1c

measurements to an online portal. They then used continuous
glucose monitoring devices to monitor their HbA1c values and
uploaded them to the portal. Upon data analysis, the researchers
noted that there was a significant reduction in the levels of
HbA1c levels (p-value of <0.001). The HbA1c fell significantly
from 8.2% (1.9%) at baseline to 7.1% (1.1%) at the end of the
study (
p < 0.001); besides, 54 % of those with
initial HbA1c values >7% experienced absolute HbA1c
reductions of >1%. This study implied that the improved HbA1c
levels among the patients are the results of continuous glucose
monitoring. Therefore, this study also indicated the importance
of continuous glucose monitoring in improving HbA1c and the
management of diabetes. Comment by Ginger King: Please
continue to work on grammar all throughout the manuscript. I
recommend working with Thinking Storm or an editor.
Comment by Ginger King: All statistical data needs to be
written in correct APA formatting.
Heinemann, L., Freckmann, G., Ehrmann, D., Faber-Heinemann,
G., Guerra, S., Waldenmaier, D., & Hermanns, N. (2018). Real-
time continuous glucose monitoring in adults with type 1
diabetes and impaired hypoglycemia awareness or severe
hypoglycemia treated with multiple daily insulin injections
(Hypo DE): a multicentre, randomized controlled trial.
The Lancet,
391(10128), 1367-1377.
https://doi.org/10.1016/S0140-6736(18)30297-6
This study was done by Heinemann et al. (2018). This
study's objective was to determine whether real-time continuous
glucose monitoring can effectively reduce the severity and
incidences of hypoglycemia. In a six-month randomized
controlled study, the researchers randomly assigned 75
individuals to a real-time continuous glucose monitoring group,

while 74 were assigned to the control groups. The individuals in
the real-time continuous glucose monitoring group were taught
how to use the monitoring system. They then used real-time
continuous monitoring devices for the period of study. On the
other hand, the individuals in the control group used self-
monitoring blood glucose. Upon the analysis of the data, it was
noted that the individuals in the intervention group reported a
significant reduction in hypoglycemic events (p-value of
<0.0001). The mean number of hypoglycemic events per month
in the continuous glucose monitoring group was reduced from
10·8 (SD 10·0) to 3·5 (4·7); changes in the control group were
not significant (from 14·4 [12·4] to 13·7 [11·6]). Incidence of
hypoglycemic events decreased by 72% for participants in the
continuous glucose monitoring group (incidence rate ratio 0·28
[95% CI 0·20–0·39], p<0·0001). The study implied that the use
of continuous glucose monitoring led to a significant reduction
in
events such as a rise in HbA1c levels hence
showing the importance of the intervention in diabetes
management and care. Comment by Ginger King: What does
this mean? They self monitor using a glucometer at certain
intervals throughout the day? Comment by Ginger King:
Remove this.
Martens, T., Beck, R. W., Bailey, R., Ruedy, K. J., Calhoun, P.,
Peters, A. L., ... & MOBILE Study Group. (2021). Effect of
continuous glucose monitoring on glycemic control in patients
with type 2 diabetes treated with basal insulin: a randomized
clinical trial.
JAMA,
325(22), 2262-2272.
doi:10.1001/jama.2021.7444
This article presents the findings of the research done

by Martens et al. (2021). This study was done with the aim of
finding the impacts of continuous glucose monitoring in
improving individuals' HbA1c levels when compared to the
impact of blood glucose meter monitoring. In a randomized
controlled trial, these researchers recruited a total of 175 people
with type 2 diabetes. While the individuals in the intervention
group used continuous glucose monitoring, the ones in the
control group engaged in blood glucose meter monitoring. This
study was done for a period of eight months. Upon analyzing
the data, it was noted that the individuals in the intervention
group showed a substantial reduction in HbA1c levels (p-value
of 0.02). There was also a significant difference between the
intervention and control groups (p-value of 0.001). Mean
HbA1c level decreased from 9.1% at baseline to 8.0% at eight
months in the continuous glucose monitoring group and from
9.0% to 8.4% in the control group (adjusted difference, −0.4%
[95% CI, −0.8% to −0.1%]; p= 0.02). The results imply that
continuous glucose monitoring leads to a more significant
reduction in HbA1c levels, indicating that the intervention is
effective.
Grace, T., & Salyer, J. (2022). Use of Real-Time Continuous
Glucose Monitoring Improves Glycemic Control and Other
Clinical Outcomes in Type 2 Diabetes Patients Treated with
Less Intensive Therapy.
24(1), 26-31. DOI: 10.1089/dia.2021.0212.
Authored by Grace & Salyer (2022), this study focused
on using real-time continuous glucose monitoring in the
management of patients with diabetes type to improve glycemic
control. The researchers recruited patients with type 2 diabetes
with basal insulin only or noninsulin therapy. At six months, the
researcher found relevant outcomes. For example, the
participants showed a considerable reduction in HbA1c levels
(−3.0% ± 1.3%, p-value <0.001). In addition, the researchers
observed a reduction in the average levels of glucose at six

months (−23.6 ± 38.8,
P < 0.001). Therefore, continuous glucose
monitoring was connected with significant glycemic
improvements among patients with type 2 diabetes. Comment by
Ginger King: Why do you have a large space here?
v) Practice Change Recommendation: Validation of the Chosen
Evidence-Based Intervention
The standards of diabetes care have been used at the facility for
years as a preference. However, this approach has not been as
effective as expected. As such, this research proposes the use of
continuous glucose monitoring as an intervention to help
patients with type 2 diabetes have improved HbA1c levels, as
shown in the research done by Beck et al. (2017). In a
randomized controlled trial, the researchers randomized (n=79)
patients in a continuous glucose monitoring group while (n=79)
were in the control group. The continuous glucose monitoring
group used a Dexcom G4 platinum continuous monitoring
system to monitor their glucose concentrations to give a better
reduction in HbA1c levels as compared to the control group (p
values of 0.022). The analysis of the study findings showed that
the mean HbA1c levels went down to 7.7 % and 8.0% in the
continuous glucose monitoring group and control group,
respectively (adjusted difference in mean change, −0.3% [95%
CI, −0.5% to 0.0%]; P = 0.022), showing that the intervention
was efficacious (Beck et al.,2017). As such, this randomized
controlled trial study shows that continuous glucose monitoring
can effectively improve HbA1c levels among patients with type
2 diabetes hence a recommendation for practice change (Beck et
al., 2017).Comment by Ginger King: Here is your PICOT:

The wording of your PICOT is actually unclear and needs to be
revised.
vi) Summary of the findings written in this section.
Diabetes is one of the most common and disabling chronic
conditions. However, the application of nursing interventions
can be key to improving patient outcomes (Beck et al., 2017).
From the annotations, it is evident that the use of continuous
glucose monitoring as an intervention in managing diabetes
leads to better outcomes. For example, the researchers reported
significant improvement in the HbA1c levels upon the use of
continuous glucose monitoring. When the results for the control
groups were compared with intervention groups, significant
improvements among the intervention groups were observed.
For example, the reduction in the HbA1 levels observed
between the intervention and control group by Beck et al.
(2017)was significant (p= 0.022); Gilbert et al. (2021) observed
(
p < 0.001), Heinemann et al.(2019) observed
(
p < 0.001); Martens et al. (2021) also
observed (
p < 0.001); Grace & Salyer observed (p
<0.001) Comment by Ginger King: I am bringing this up now
as this may be an obstacle for your project. Some insurances
will not cover CGM and the deductible for those that do may be
a factor for patients not electing to do CGM. Also, the self pay
price is pretty steep. How are you going to account for this?
Problem Statement
3)
Problem Statement:
Describe the variables/groups to project in one sentence.
It is not known if the implementation of the translation of
research by Beck et al. (2017) on continuous glucose monitoring
to improve the rate of practitioners' ordering continuous glucose

monitoring would impact HbA1c levels among patients with
type II diabetes.
PICOT to Evidence-Based Question
4)
PICOT Question Converts to Evidence-Based
Question:
Evidence-Based Question:
Provide the templated statement.
To what degree will the implementation of continuous glucose
monitoring impact HbA1c levels among adult patients with type
two diabetes in an urban outpatient clinic in Houston?
Comment by Ginger King: Please do not identify the city.
Also, your EB ? needs to align with the PICOT.
Sample
Setting
Location
Inclusion and Exclusion Criteria
5)
Sample, Setting, Location
i) Sample and Sample Size: The sample will be based on a
convenient sample of 50 adult patients diagnosed with type 2
diabetes. One of the potential biases is selection bias, as the
patients recruited will be ones known to the facility and
attending the facility for the management of diabetes. Another
potential bias is that the samples will be from one center, hence
a lack of generalizability. A sample calculator will be applied to

calculate the appropriate number of study subjects to participate
in the project prior to implementing the project at the center.
Comment by Ginger King: You sample population will be
those that obtain the CGM device, correct? Is it practical to
have this many patients change from their current device to the
CGM in the OP setting? This device is hundreds of dollars and
may be financially difficult for some patients to make the
switch. Comment by Ginger King: Tell us about the G power
calculation you did to obtain a sample size of 50 patients.
ii) Setting: The setting for the study is an urban Outpatient care
primary clinic in HoustonComment by Ginger King: Remove the
city. You should not include anything that could identify your
facility.
iii) Location: an outpatient primary care Clinic area in
Houston, Texas. Comment by Ginger King: See above
feedback
iv) Inclusion Criteria
Patients must be at least 18 years and above and have type 2
diabetes. The patients should also be able to speak and
understand English. The patient should also not form part of
another study. The research subjects must be willing to
participate in the study and must be mentally stable.
Comment by Ginger King: Research subjects is not correct
terminology. You are not conducting research. Comment by
Ginger King: What does mentally stable mean? How will you
define this and does it really matter?
v) Exclusion Criteria
Patients under the age of 18 years will be excluded. Those who
have other types of diabetes apart from type 2 diabetes will be
excluded. Individuals using technological management of
diabetes, those who do not want to sign the consent forms, and
those who have a mental disability will be excluded.
Define Variables
6)
Define Variables:

i) Independent Variable (Intervention): continuous glucose
monitoring
Continuous glucose monitoring: Continuous glucose monitoring
is a technological process of automatically tracking a person’s
glucose concentrations throughout out the night and day.
ii) Dependent Variable (Measurable patient outcome): glucose
concentrations and HbA1c levels Comment by Ginger King:
You are only measuring HgA1C levels per your PICOT
Glucose concentrations: In reference to this project, blood
glucose levels refer to the amount of the glucose in the patient’s
system as measured by the continuous glucose monitors.
HbA1c levels: In reference to this project, HbA1c levels refer to
average glucose concentrations measured at baseline and at the
end of the intervention to determine the efficacy of the
intervention
Project Design
7)
Project Design:
This project will use a quality improvement approach.
i. Quality Improvement: A quality improvement is an initiative
or project focused on improving patient care efforts and
outcomes. These initiatives focus on initiating changes to lower
the chances of making medical errors, improving care, and
ensuring safety. Quality improvement efforts also help
formulate processes and standard work to bridge gaps for better
patient outcomes. Quality improvement is vital in improving an
organization’s performance and reducing costs. According to
Fischer & Wick, 2020, quality improvement is key in delivering
quality patient care composed of six aspects; patient-centered,
equitable, timely, efficient, effective, and safe. Therefore, the
use of the quality improvement approach in this study will seek
to explore current research and translate the found evidence into
practice for the major purpose of improving patient outcomes,
which in this case is better HbA1c levels among patients with
diabetes type 2. As opposed to research, quality improvement
uses the existing evidence and translates the same into practice.

ii) Research: Research entails replicating or testing new ideas to
improve the standard practice and current knowledge. A
systematic strategy is applied to investigate a clinical question
or problem, leading to the formulation of a hypothesis which
then triggers efforts to prove such hypothesis and generate new
knowledge (Glasofer & Townsend, 2021). Research is
significant in nursing in that it produces scholarly evidence,
which is then used as a guide to the professional nursing
practice. Research differs from quality improvement in that it
applies a systematic strategy to investigate a new idea and come
up with new knowledge and theories. Therefore, research
informs quality improvement.
iii) Summarize: Research and quality improvement both
complement each other in terms of improving patient care
outcomes. In addition, even though the two are connected, they
are different. While research mainly formulates new knowledge,
theories, and hypotheses, quality improvement focuses on
translating the research findings into practice
Purpose Statement
8)
Purpose Statement:
Provide the templated statement.
The purpose of this quality improvement project is to determine
if the implementation of continuous glucose monitoring would
impact HbA1c levels among adult patients with type 2 diabetes.
This project will be piloted over a twelve-week period in an
urban Outpatient primary care clinic in Houston. Comment by
Ginger King: This does not align with your PICOT. Be sure to
revise
9)

i) The demographic information or data for the patients, such as
gender, co-morbidities, ethnicity, race, and age, will be
collected. The demographic data for the patients will be
collected through documentation during recruitment as provided
by the patients. The patient's knowledge of continuous glucose
monitoring will also be evaluated using a questionnaire
(Revised Brief Diabetes Knowledge Test instrument). The
reliability of the Revised Brief Diabetes Knowledge Test
instrument is (α ≥ 0.70), while the validity ranges from 0.83 to
0.96
ii) The patient's HbA1c levels will be measured, and the
baseline data will be obtained from the electronic health
records. Data from EHR has been shown to be reliable and
valid. The obtained data at the end of the study period will then
be entered into a password-protected database.
iii) 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. Comment by Ginger King:
Please do not use first person. Use scholarly writing.
Step 1: Obtaining IRB approval for data collection
Step 2: The patient will be given the questionnaire testing their
knowledge of continuous glucose monitoring Comment by
Ginger King: Is this needed? Remember, you are replicating the
original research- not creating a project and tools.
Step 3: Baseline patient HbA1c data will be obtained from the
facility’s EHR.
Step 4: The patient's HbA1c will be measured after the
intervention, and the two values will be compared. The results
will also be compared between the intervention and the control
group. For protection, data will be coded, while access will
only be given to authorized persons with passwords.
Comment by Ginger King: Based on what is written here, I
cannot tell what your project is. Think of it like a recipe. You
are telling your reader how to replicate the project.
iv) Various potential ethical issues include the protection and

storage of patient health information. This information will be
stored in password-protected computers where only individuals
with unique passwords will access the information. The patient
data will also be de-identified to further improve security and
confidentiality. In addition, the obtained data will be kept for
one year after graduation before destroying them, following the
Grand Canyon's guidelines.
v) The project will adhere to the principle of Belmont by
ensuring that no harm is done to the patients. Patients will also
be encouraged to participate in the study without coercion
freely. Besides, none will be unfairly excluded from
participating in the study. Patient data will also be protected to
remain confidential and unauthorized access blocked. The
patients will be shown the necessary respect in terms of
autonomy and be treated without bias, just, fairly, and equally.
10)
i. The participant's data will be analyzed using the IBM SPSS
statistics software. The central tendency measures will be used
in summarizing the characteristics of the patients. They will be
the mean or average of continuous and discrete data and the
median.
ii. Descriptive statistics will be applied in analyzing the
collected demographic data such as gender, co-morbidities,
ethnicity, race, and age.
iii. Descriptive analysis will also be used to describe the
population as well as what happens with the computation of
standard deviations, median, and mean. It will also help in
describing the variables and their relationships through the use
of a mixed linear regression model.
iv. Data will be obtained from EHR and the continuous glucose
monitoring database platform.
v. There will be a review of the HbA1c levels obtained using
continuous glucose monitors.

vi. Paired sample t-test and Pearson's correlation will be used to
determine the significant differences between the intervention
data and baseline data and between the groups.
vii. A statistician will also be consulted to help with the
statistical aspects of the project.
Potential data bias can result in the possible improved glycemic
control could be as a result of the intervention and other self-
care activities that the patient undertakes outside the study. One
way of mitigating data is through the use of an appropriate
study design. The Hawthorne effect is also possible since the
patients will be in the know that they are part of the study and,
therefore, their behavior is being monitored. Comment by
Ginger King: Please revise based on your project design.
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