Directions:
Complete a draft of your DPI Project prospectus according to the instructions and criteria provided in each section of the prospectus template. The draft should include information taken from “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” document (from previous courses). Use the “Academic Quality Review Checklist (AQR)” (Chapters 1-3 only) to assist you in writing this prospectus. Include the following sections in the prospectus:
1. Introduction: Provide an overview of your project.
2. Background of the Problem: Provide an overview of the history and present state of the problem.
3. Theoretical Foundations: Identify and describe one or two theories or models to be used to inform the project. Identifies the seminal source for each theory or model (a seminal source may be quite old and may be published in a textbook). Illustrate how the theory or model will inform your project.
4. Review of the Literature/Themes: Describe the main and subthemes of your project. You should begin with at least three main themes with three subthemes each. Your literature review will eventually be 30+ pages with over 50 references (85% of these references must be from primary sources that is less than 5 years.
5. Problem Statement: Specify the problem proposed for the project by presenting a clear declarative statement that begins with “It is not known . . . .” Identify the need for the project. Identify the broad population (not the sample) for the project. Describe how this project may contribute to solving the problem.
6. Purpose of the Project: Describe the purpose of this project. Use a declarative statement “The purpose of this project is to . . . .” Describe the methodology and design. Describe the specific population that this project will affect and how this project will contribute to the field.
7. Clinical Questions and Variables: Provide a brief introduction to the question portion. State your clinical questions or PICOT questions. Describe and operationally define each variable of interest.
8. Significance of the Project: Provide an overview of how this project fits with other research in the field. Be specific and relate to other studies. How will this project contribute to the research overall? What is the expected value?
9. Rationale for Methodology: Clearly justify the methods chosen for this project. Ensure the methods align with the project questions or PICOT questions. Describe why this method is the best fit.
10. Nature of the Project Design: Describe the design you have chosen for this project. Discuss why this design is appropriate based on the method chosen and the project questions.
11. Instrumentation or Sources of Data: Describe the sources of data you will use. One source must be a valid and reliable tool, survey, or questionnaire. You may use your discussion question from Topic 3 to assist with this section. Describe in detail all data collection instruments. Describe the validity and reliability of each as appropriate (one must be valid and reliable).
12. Data Collection Procedures: Describe step by step how you will collect data. All major steps need to be described. Include a discussion of project sample recruitment, sample selection, and assignment to groups (as applicable). Describe the process of obtaining informed consent, if applicable.
13. Data Analysis Procedures: Begin by describing your demographic data from your participants. How will you analyze this data using descriptive statistics? Restate each project question or PICOT question. For each question, describe in detail what inferential statistics you will use to analyze your data. Include steps to ensure your data meet the assumptions for each inferential statistic used. Describe the a priori alpha level you plan to use.
14. Ethical Considerations: Provide a description of ethical issues related to your project and how you plan to deal with them. Consider your methodology, design, and data collection. Compare to a randomized controlled trial. Address anonymity, confidentiality, privacy, lack of coercion, informed consent, and potential conflicts of interest. Discuss how you plan to adhere to the Belmont Report key principles (respect, justice, beneficence).
PICOT QUESTION
�Will educating type 2 diabetes patient ages 30-65 on the importance of medication adherence and lifestyle modification on their regular office visit improves their fasting blood glucose
Draft Prospectus
Introduction
Diabetes is a medical condition that is primarily characterized by the failure of the body’s mechanisms to control the amount of blood glucose. The elevation of the level of the glucose in the blood is responsible for the occurrence of both the acute and long-term complications associated with the condition. According to the Centers for Disease Control and Prevention (CDC), the prevalence of type 2 diabetes mellitus (T2DM) is 30.2 million in the USA. Among the Americans aged 45 to 64 years, the prevalence of (T2DM) is 17.0 million. 30.2 million Americans aged above 65years have been diagnosed with T2DM. In other words, population aged between 44 to 65 years of age and above represent the group of Americans with the highest T2DM prevalence (Powers, Bardsley, Cypress, Duker, Funnell, Fischl, & Vivian, 2017; Rutledge, Masalovich, Blacher, & Saunders, 2017).
Patient education is one of the treatment modalities in managing T2DM. Diabetes is a long term condition. The Diabetes Self-Management Education (DSME) is the incorporation of skills and knowledge of managing the condition to patients (Humphreys, Sharry, Dinneen, & Byrne, 2017). DSME aims at promoting self-care among the T2DM patients. The objectives of DSME include the ability to form informed decisions, ability to solve the presenting problems, ability to improve patient outcomes , to improve the quality of care and to promote continuous collaboration between the patients and the clinicians (Chrvala, Sherr, & Lipman, 2016; Yorke, & Atiase, 2018). The elements of DSME include; proper eating habits, physical exercises, medication administration, and monitoring the development of warning symptoms.
According to a random controlled trial, a review of studies found out that 90 % of the studies focused on the mode of delivering DSME, the components of the DSME; structured verses unstructured and individual based versus group-based. Several studies have investigated the impact of self-care education on the ability to control blood glucose, lifestyle modification including nutritional care, cognitive and psychological well-being, and loss of body weight and control of body lipids (Ferguson, Swan, & Smaldone, 2015). According to a study by Ahren, (2015) patient education results into a general inability to control the levels of blood glucose. According to the same study, education of patients on self-management includes training on the importance of medication towards the reduction of the blood sugars and the impact of glucose levels — fasting blood glucose on development of complications (Steinsbekk, Rygg, Rise, & Fretheim, 2015). Further, patient education is responsible for the recognition and prevention of elevated blood glucose levels. As revealed from previous studies, research has only focused on the control of blood glucose generally. Studies have not focused on the management of fasting blood sugars as an indicator of the impact of patient education. The previous studies have also focused on the population affected by T2DM generally but has not specifically focused in the T2DM patients aged between 30 to 65 years of age.
Background of the Problem
For decades, the management of T2DM has involved both the pharmacological and non-pharmacological approaches. Patient education has been applied as one of the non-pharmacological approaches to managing T2DM. Over time, several studies have focused on the effectiveness of the treatment modalities (Li, Li, Tang, Meng, Mao, Sun, & Chen, 2018; Odgers-Jewell, Isenring, Thomas, & Reidlinger, 2017). The studies have focused on the impact of DSME on the cognitive and emotional well-being of the patient, weight management and blood pressure control. The evaluation of the effectiveness of the findings of the various studies has focused on the impact of self-management education programs. Colungo, Liroz, Jansa, Blat, Herranz, Vidal, (2018) conducted a study on the impact of patient education on the ability of the T2DM patients to manage symptoms. The study concluded that educational programs on the management of diabetes type 2 results into improvement in the knowledge on the importance of medication adherence, knowledge on weight management and physical exercises, and nutritional adjustment (Garrison, 2015; Miller, 2016). A similar study found out that there is a close association between patient education and the ability to modify the activities of daily living, regulation of the blood sugar levels and recognition of symptoms (Humphreys, Sharry, Dinneen, & Byrne, 2017). The patients who had received education on self-management had low prevalence and mortality of T2DM complications. Although there is a clear association between patient education and improved control over blood sugar levels among T2DM patients research has not focused on the impact of patient education on lifestyle modification and adherence to medication.
Additionally, research does not inform on the impact on patients’ education specifically on fasting blood sugar. Previous research studies focus on blood sugars generally, without particular investigation on the impact T2DM on the level of fasting blood sugar. Still, research studies need to focus on the age group between the ages of 30 to 65 years where the prevalence of T2DM is the highest.
Theoretical Foundations/Conceptual Framework and
The theoretical model used is the Evidence-Based Model of clinical practice. According to the model, practice, education and research impact one another. External factors such legalization and national and state standards of care are informed by evidence based research (Walvoord, 2018). Data that directs practice is obtained from clinical research. Additionally, the data is either obtained from non-research processes such as patients’ preferences or empirical research (Dang, & Dearholt, 2017). The impact of education on medication adherence and lifestyle modifications on control of fasting blood glucose is relevant to the model. The results of this project will inform the clinicians on the content of the T2DM self-care education, the mode of delivery and the targeted T2DM patients aged between 30 to 65 years (Lee, Tsou, Lim, Koh, Ong, & Wong, 2015).
Literature Themes
Patients’ education improves glucose control through close monitoring of symptoms (Fitzpatrick, Golden, Stewart, Sutherland, DeGross, Brown, & Briggs, 2016). Part of the elements of education program of self-management includes monitoring of the blood sugar levels by taking the measurements of the fasting blood sugar before and after a meal. Siminerio, Albright, Fradkin, Gallivan, McDivit, Rodríguez, & Wong, (2018) found out that the National Diabetes Patients Education Program improves the patients’ ability to monitor and prevent complications resulting from the progression of T2DM.
Prevention of cardiovascular complications is another benefit of patient education in T2DM (Briggs, 2016; Hill-Briggs, Renosky, Lazo, Bone, Hill, Levine, & Peyrot, 2016). Education to patients across all the age groups has been found to reduce the incidence of cardiovascular complications of T2DM, including coronary heart disease. Patients’ education focuses on modalities of lifestyle changes such as weight management and nutritional management. The quality of life is measured by the ability of the patient to undertake the activities of daily living. The type of nutrition determines the level of blood glucose in the body (Cunningham, Crittendon, White, Mills, Diaz, & LaNoue, 2018).
Problem Statement
According to the previous studies reviewed, research has not focused on the impact of patients’ education on adherence to medication and lifestyle modification on the control over the fasting blood sugar levels. Studies have however not addressed the impact of DSME among patients population aged between 30 and 65 years of age. The two elements of patient educations; adherence to medication and modification of lifestyle have not been measured independently on their impact to fasting blood glucose control (Fard, & Mojtabaei, 2016; Rees, O’Hare, Saeed, Sudholz, Sturrock, Xie, & Lamoureux, 2017). The two elements of T2DM are closely related to the levels of blood sugar in the body. The determination of their contribution to controlling fasting blood glucose will form basis on which the content of the patient’s education programs and the mode of delivery of the educational programs are built. Failure of the knowledge on the contribution of medication adherence and lifestyle modification on the levels of fasting blood sugar could be contributing to inappropriate educational programs, and inappropriate use of healthcare resources in managing T2DM ( de Vries, Heather, Boyle, Rooney, & Bogner, 2016 ; Graumlich, Wang, Madison, Wolf, Kaiser, Dahal, & Morrow, 2016).
Purpose
The purpose of this study is to determine the impact of patients’ education on lifestyle modifications and adherence to medication on the inability to control fasting blood sugar among T2DM patients aged 30 to 65 years of age attending diabetes care clinic through longitudinal study design.
Research Questions
RQ1; What is the impact of patient education on medication adherence on fasting blood sugar levels among patients aged 30 to 65 years?
RQ2; What is the impact of patient education on lifestyle changes on fasting blood sugar levels among patients aged 30 to 65 years?
Hypotheses
H1; Patient education on medication adherence increases the ability to control fasting blood sugar among T2DM aged 30 to 65 years.
H2; Patient education on lifestyle modification increases the ability to control fasting blood sugar among T2DM aged 30 to 65 years.
Advancing Scientific Knowledge and Significance of the Study
The study project will address the lack of knowledge on the contribution of medication adherence and modification of lifestyle on informing the care for T2DM patients. The previous studies have not focused on the T2DM patients aged between the 30 to 65 years of age.
Rationale for Methodology
The methodology of this research is qualitative since it seeks to establish how patient education impacts on the ability to control blood glucose. The independent variable is the patient medication whereas the dependent variable is the ability to control the fasting blood glucose level (Figueroa, Alcocer, & Ramos, 2016).
The study by Keyserling, Samuel-Hodge, Ammerman, Ainsworth, Roldán, Elasy, & Bangdiwala, (2013) and Peña-Purcell, Jiang, Ory, & Hollingsworth, (2015) and Ruggiero, Riley, Hernandez, Quinn, Gerber, Castillo, & Butler, (2014) used qualitative methodologies to study the influence of T2DM on the quality of life and control of symptoms by patients.
Nature of the Research Design for the Study
For the purpose of this project, theresearch design that will be used for this study is the longitudinal research design. The longitudinal research design is appropriate since it will enable the collection of data on the impact of patient education over a given period of item (Crabtree, 2016; Fokkens, Wiegersma, Beltman, & Reijneveld, 2015). Patients’ education is carried out during several clinical visits. The impact of the patients’ education on fasting blood glucose control will, therefore, be observed across an extended period.
Sources of Data
The data for the project will be obtained from patients diagnosed with T2DM and attending the diabetic clinic. The patients will provide data on the medications they have been receiving and adherence to medication and modification of lifestyle. Clinical records will be a source of data on the levels of blood sugar measured data from different clinical visits.
Data Collection
Data will be collected through structured questionnaires. The questionnaires will be administered by the respondents. Further, data will be collected into a template from the clinical records.
Data analysis
The date will be analyzed through prose form since it is a qualitative data. The data will be analyzed in term of the components of the patient education programs offered to the patients. The impact of the patient education will be described in terms of its control on the blood sugar levels in prose form as well.
Ethical Consideration
Permission to conduct the study will be sought from the administration of the hospitals from where the data will be collected. Informed consent will be sought from the respondents before collecting the data. Anonymity will be maintained throughout this study by avoiding identification by patients by their actual names. Respondents will be identified my codes.
References
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