DNP- 10 Strategic Points

I need help to fix my DNP 10 Strategic Points. I have attached my original with the Professor’s feedback for what needs to be corrected in it. Please see my school’s Template attached and another one that is already completed by another student to use to update mine.

The 10 Strategic Points for the Prospectus and Direct Practice Improvement Project

Introduction

In the Direct Practice Improvement (DPI) 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. 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 project site.

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 the quality improvement project. It is important to align all of the 10 Strategic points to ensure it will be possible to conduct and complete the project.

Developing the 10 Strategic Points document begins in DNP-815A begins as a three-page document that can help ensure clarity, simplicity, correctness, and alignment of each of these 10 Strategic Points in the Direct Practice Improvement Project. This document is integral to learner success in the project courses. Therefore constant updates should be made through each course as you develop the project. Please see the table below regarding the development of the citation requirements expected per course.

Course	Minimal number of articles
DNP-801A	Begin collecting original research to support the evidence-based practice intervention found in the research or clinical practice guidelines.MUST have 2 original research articles from the USA (or Canada if Canadian student) to support the intervention within five years of your graduation date.
DNP-815A	Must have a total of 5 original research articles:MUST have 2 original research articles from the USA (or Canada if Canadian student)to support the intervention within five years of your graduation date. Other 3 research articles may be added from US, Canada, UK, Denmark, India, New Zealand, Germany, or Australia.
DNP-820A	Must have a total of 15 original research articles:MUST have 2 original research articles from the USA (or Canada if Canadian student) to support the intervention within five years of your graduation date. Other 3 research articles may be added from US, Canada, UK, Denmark, India, New Zealand, Germany, or Australia.Any other original research can come from any of the 131 countries listed in the International Compilation of Human Research Standards 2020) found here:https://www.hhs.gov/ohrp/international/compilation-human-research-standards/index.html
DNP-830 (A)	These points should have been completed and ready for use in DNP-830A to support the drafting of the DPI project. All criteria from DNP-820A should have been met and revised.

Value of the 10 Strategic Points Document

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 implement their DPI project. The document also proves useful for communicating the DPI project focus with the Content Expert, as well as for reviewing the DPI project with the Project Chair, mentor, content expert, and academic quality review (AQR) process. (Delete all of the information above when submitting the document as to keep the GCU logo)

Example: 10 Strategic Points Document for a Quality Improvement Project

Ten Strategic Points

The 10 Strategic Points
Title of Project	1) Title of ProjectList the title of the project/manuscript to include the intervention and no more than 12 words
BackgroundTheoretical FoundationLiterature SynthesisPractice 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 siteii) Significance of the practice problem/gap at the project siteiii) Theoretical Foundations (choose one nursing theory and one evidence-based change model to be the foundation for the project):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.v) Practice Change Recommendation: Validation of the Chosen Evidence-Based Interventionvi) Summary of the findings written in this section.
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 is not known if the implementation of __________________would impact_______________ among ___________ (population).
PICOT to Evidence-Based Question	4) PICOT Question Converts to Evidence-Based 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?Evidence-Based Question:Provide the templated statementTo what degree will the implementation of _______________ (intervention) impact______________(what) among _____________ (population) patients in a ______ (setting) in _______ (state)?
SampleSettingLocationInclusion and Exclusion Criteria	5) Sample, Setting, LocationIdentify sample, needed sample size, and location (project phenomena with small numbers and variables/groups with large numbers).i) Sample and Sample Size: Population (participants whose outcomes are measured) and number based on G*power analysis or sample size calculator. Explain potential bias and mitigation of sample size.ii) Setting: Clinic, hospital, parish nursing, community center, medical-surgical,…..iii) Location: urban / rural then what state: iv) Inclusion Criteria· Who can participate?v) Exclusion Criteria· Who cannot participate
Define Variables	6) Define Variables:i) Independent Variable (Intervention):ii) Dependent Variable (Measurable patient outcome):
Project Design	7) Project Design:This project will use a quality improvement approach. You must be able to explain and cite the difference between research and quality improvement (one paragraph each).i) Quality Improvementii) Researchiii) Summarize
Purpose Statement	8) Purpose Statement:Provide the templated statement.The purpose of this quality improvement project is to determine if the implementation of _________________ (intervention, make sure you have the evidence-base here) would impact ______________(what) _______________________ among ___________(population). The project was piloted over an eight-week period in a (rural, urban)________ (state) ________ (setting i.e.: primary care clinic, ER, OR).
Data Collection Approach	9) Data Collection Approach:i) You will need data on your participants demographic information (example: age, gender, educational background, ethnicity…..etc.). What instrument would you use to measure this? (Will you use a pre-made Likert Scale? An Excel Spreadsheet?)ii) You also need data on the measurable patient outcome. What instrument will you use (survey, electronic health records, instrument) to obtain this data and how is it determined to be valid and reliable.iii) For the instruments used to measure data provide the reliability and validity (psychometric studies) for each.iv) 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.1.2.v) 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.)vi) 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.
Data Analysis Approach	10) Data Analysis Approach:How will you analyze the participants’ descriptive, demographic information? What statistical analysis will be used to prepare the results?What type of data analysis will be needed to analyze the measurable patient outcomes? What statistical test will be used? (i.e. chi-square, paired t-test, Wilcoxon…)Will you use Intellectus, Laerd Statistics, or a statistician?Discuss the potential Bias and Mitigation of the data.

Vera Uzoma

Grand Canyon University

DNP-830A: Data Analysis

Dr. J. Schlickau

October 6, 2022

10 Strategic Points Document for a Quality Improvement Project

Ten Strategic Points

The 10 Strategic Points
Title of Project	1) Title of ProjectUsing continuous glucose monitoring to monitor blood glucose in adult patients with type II diabetes
BackgroundTheoretical FoundationLiterature SynthesisPractice Change Recommendation	2) Background to Chosen Evidence-Based Intervention:List the primary points for six sectionsi. Background of the practice problem/gap at the project siteSeveral 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. Indeed, uncontrolled levels of HbA1c have been connected to myocardial infarction and stroke disease (Azhar et al., 2022). It hurts to use an invasive glucometer. The discomfort is the same even if the needle is very small. Some individuals may be able to adjust to it and tolerate it, but for others, it may be too much to handle, leading to the issue of non-compliance. The patient’s ability to regulate their blood sugar may suffer as a result, leading to bouts of hyperglycemia and hypoglycemia The risk of diabetic complications is increased by noncompliance, making it a potentially life-threatening issue, hence the need to have a different way to measure glucose more effectively and non-invasively.ii. Significance of the practice problem/gap at the project siteAs 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). Modern intensive diabetic care relies on regular and precise monitoring of blood glucose levels. This used to require many time-consuming and uncomfortable daily random blood glucose readings, which served as a substantial deterrent to reaching intended blood glucose targets. Self-monitoring blood glucose (SMBG) simply gives you a single reading of the blood sugar level and doesn’t tell user anything about the trend or pace of the sugar levels even if used consistently. This means that most individuals, notwithstanding the checking their glucose concentration multiple times a day, nonetheless fail to meet their goals. CGM is a major improvement because it offers immediate evaluation on the efficacy of diabetic therapies (such insulin delivery), and it gives alerts when serum sugar levels reach critically excessive or inadequate. more importantly, it offers real-time glucose reading at regular intervals. This is significant to the research, since benefits of CGM out do the shortcomings, which include high cost.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 (Orem & Calnan, 1972). 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 outcomes.Lewin’s change theory 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 (Lewin, 1947). 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. 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 to reduce HbA1c levels in diabetic patients. 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 facility.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. When continuous glucose monitoring was performed, there was a statistically significant decrease in HbA1c levels among the patients in the intervention groups. As a result, it suggests that continuous glucose monitoring is essential for enhancing diabetic outcomes like lowered HbA1c levels.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.2020.0666The 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 <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.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)30297-6This 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 glucometer to self-monitor their blood glucose levels at regular intervals during the day. 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 HbA1c levels hence showing the importance of the intervention in diabetes management and care.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.2021.7444This 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.  Diabetes Technology & Therapeutics,  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.v. Practice Change Recommendation: Validation of the Chosen Evidence-Based InterventionThe 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 to investigate whether the increased prescription 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).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 a better control in patient’s blood glucose, even though the cost of purchasing it is significantly higher. 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)
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: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?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.
SampleSettingLocationInclusion and Exclusion Criteria	5) Sample, Setting, Locationi) Sample and Sample Size: The sample will be based on a convenient sample of 16 adult patients diagnosed with type 2 diabetes. the sample will then be divided into two, the control group and the intervention group, each having 8 patients. 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.The sample size of 16 patients is obtained by taking 10% of the total diabetic adults who visit the hospital, which is 160 patientsii) Setting: The setting for the study is an urban Outpatient care primary clinic.iii) Location: an outpatient primary care Clinic areaiv) Inclusion CriteriaPatients 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 participants must be willing to participate in the study and must be competent in that they should be able make sound decisions on their own.v) Exclusion CriteriaPatients 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 monitoringContinuous 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): HbA1c levelsGlucose 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 increased prescription 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.
Data Collection Approach	9) Data Collection Approach: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 0.96ii) 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) The step-by-step process for collecting the data,Step 1: Obtaining IRB approval for data collectionStep 2: Baseline patient HbA1c data will be obtained from the facility’s EHR.Step 3: 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.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.
Data Analysis Approach	10) Data Analysis Approach: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 kept under watch
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