Capstone Project
In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Develop a 2,500-4,000 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal: Background Clinical problem statement. Purpose of the change proposal in relation to providing patient care in the changing health care system. PICOT question. Literature search strategy employed. Evaluation of the literature. Applicable change or nursing theory utilized. Proposed implementation plan with outcome measures.
Discussion of how evidence-based practice was used in creating the intervention plan. Plan for evaluating the proposed nursing intervention. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome. Appendix section, for evaluation tools and educational materials, etc. are created. Review the feedback from your instructor on the PICOT Question Paper, and Literature Review.
Use this feedback to make appropriate revisions to these before submitting. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Capstone Project Change Proposal
Student’s Name
Institution
Course
Instructor’s Name
Date
Capstone Project Change Proposal
Background
Diabetes is a big threat to public health systems across the world. The incidence of diabetes mellitus is increasing across the world, making it a serious concern to governments and other healthcare stakeholders (Houghton et al. 2018). The National Diabetes Association has indicated that diabetes accounts for 8.3% of the total population globally and the number is expected to reach about 592 million people by 2030. Diabetes causes serious complications such as cardiovascular disease, neuropathy, hypertension, and others (Kim & Hur, 2021).
The core of diabetes care is self-management, which comprises lifestyle modification and self-monitoring of blood glucose levels. The use of non-pharmacological interventions has proven to be effective in managing blood sugar levels and other symptoms of diabetes, (Kim & Hur, 2021). Type 2 diabetes is a serious health problem that requires relevant evidence-based solutions to manage.
Type 2 diabetes mellitus (T2DM) is among the largest and fastest-growing health problems associated with high morbidity and mortality. Type 2 diabetes takes evidence-based solutions and nursing interventions to prevent or manage it (Correia et al., 2022). Proper patient education is required for people who are pre-diabetic to delay or prevent the disease onset and those with the disease to enhance management practices.
Clinical problem statement
The care setting had noticed an increased rate of type 2 diabetes incidences in the area and indicated that the incidences might rise if nothing is done about it. The assumption is that most people lack knowledge regarding diabetes including preventive measures (Correia et al., 2022). Therefore, there is a need to conduct community-based education regarding type 2 diabetes and a healthy lifestyle to reduce the incidences. Public education is considered a powerful evidence-based intervention to prevent type 2 diabetes (Saleh et al., 2017).
Knowledge is essential for both the prevention and management or treatment of type 2 diabetes. The American Diabetes Association recognizes that lack of knowledge about the disease among citizens is a major problem that supports this PICOT problem (ADA, 2022). Consequently, the American Diabetes Association offers educational programs to patients, families, and communities. Diabetes can lead to detrimental health effects on the individual (Rafie et al., 2021). It leads to heart failure, lower limb amputation, and others. Type 2 diabetes is associated with bad signs such as increased thirst, and urination, blurred vision, and tingling sensation (Harris, 2022). Therefore, there is an urgent need to reduce prevalence.
Purpose
The purpose of the capstone change proposal is to examine the effects of community-based diabetes and healthy lifestyle education on disease knowledge and prevalence over six months.
PICOT question
In patients residing in high prevalence areas (P), what are the impact of community-based diabetes and healthy lifestyle education (I) compared to no education (C) on the disease knowledge and prevalence (O) over six months (T)?
Literature search strategy employed
A good literature search strategy is important to retrieve only reliable and valid research studies. It involves an organized structure of key terms used to search databases to retrieve relevant articles. For this study, different databases were used to retrieve literature for use.
This study is based on credible and reliable sources of evidence (Harris, 2022). Peer-reviewed articles were searched using keywords such as diabetes, type 2 diabetes, diabetes education, patient education, community-based education, healthy lifestyle, and diabetes prevalence. Various types of research studies were selected for review, including a systematic review of randomized control trials, quasi-experimental studies, systematic review and meta-analysis, and randomized controlled trials.
Eight of these studies were searched from various online databases These databases include Google Scholar, CINAHL Ultimate, Cochrane Library, PubMed Central, SAGE Journals, and ScienceDirect (Metonnou et al., 2022). These studies were published in different journals, including Research Square, Rural and Remote Health, Primary Care Diabetes, Oman Medical Journal, Diabetes Spectrum, and others.
Evaluation of the literature
These studies exploited research questions that are relevant to the proposed research. For Gutierrez (2020), the research question states: Can online diabetes education programs in schools enhance the diabetes management of students with the disease? Harris. (2022) hypothesized that diabetes self-management education for patients with type 2 diabetes can improve patients’ self-efficacy and glycemic control.
For Rafie et al. (2021) the study question is what is the effect of the Balanced Living with Diabetes program (BLD) on blood glucose control, self-management, and lifestyle behaviors. T-Malek & Ahmad, (2022) hypothesized that Web-based educational programs will improve diabetic self-efficacy management (DSEM) and diabetic self-care behavior management (DSCM).
In addition, Moreno et al. (2019) hypothesized that Spanish Diabetes Self-Management Program (SDSMP) is more effective for type 2 diabetes care. The hypothesis by Dietz et al. (2022) is that community-based diabetes self-management support (DSMS) will improve Patient Activation Measure (PAM) scores. Metonnou et al. (2022) hypothesized that community-based education on lifestyle changes will improve metabolic indicators and intensity of leisure activity and dietary score in type 2 diabetes patients. Finally, Alkaabi et al. (2021) hypothesized that community-based (family-oriented) diabetes education is effective in the prevention of type 2 diabetes mellitus.
Gutierrez (2020) used the purpose-sampling method. The sampling population includes employees from 36 rural school districts within South Central Texas. Participants included those who completed level two (non-medical personnel) and level three (continuing nursing education (CNE)) training. The sampling population included nurses, teachers, principals, bus drivers, and food service staff. Harris (2022) recruited six patients with type 2 diabetes mellitus in a primary care setting. Initially, the 11 participants agreed to take part however, 5 did not show up for the training. The sample population recruited by Rafie et al. (2021) included adults with type 2 diabetes. A total of 291 participants were recruited for the study.
Furthermore, T-Malek & Ahmad, (2022) carried out a study whose sampling population was type 2 diabetes patients who attended an orthopedic treatment clinic at Hospital Sultanah Nur Zahirah (HSNZ) Kuala Terengganu. There were 120 participants divided into intervention groups (IG) (n = 60) and control groups (CG) (n = 60). Dietz et al. (2022) recruited participants at community-based locations such as churches and activity centers.
Participants included adults who had a clinical diagnosis of either type 1 or type 2 diabetes. Additionally, Moreno et al. (2019) recruited adult patients diagnosed with type 2 diabetes mellitus. Patients aged 80 years and above and those with mental disorders were excluded. The sample population Metonnou, (2022) were residents of the municipality of Tchaourou, aged 15 to 60 years, of both sexes, and at risk of type 2 diabetes mellitus. Lastly, Alkaabi et al. (2021) recruited a sample population that included e people who are overweight or obese, between 18 and 55 years old, and having one parent with type 2 diabetes mellitus.
Besides the strengths of the studies including clear research methodologies, they also have some limitations. Gutierrez (2020) identified some limitations including that the data were limited to school workers (the nurses and other laypersons who completed the online program) in South Central Texas. This situation could have affected the study’s generalizability. Harris. (2022) had a small sample size whereby only six individuals participated in the study. Rafie et al. (2021) was not a randomized study. T-Malek & Ahmad (2022) was a single-site study, which has a negative influence on its generalizability.
Moreno et al. (2019) conducted a study based on a convenience sample; hence, people willing to participate may have not been representative of the target population. Dietz et al. (2022) reported that only those who completed the intervention collected post-intervention PAM scores, however, there is a possibility that people who did not complete the full intervention differed from those who did.
Limitations of the study done by Metonnou (2022) did not include a clear number of all participants. However, the treatment group has between 8 and 10 participants, which is a small sample size. For Alkaabi et al. (2021), the limitations of this pilot study are its nonrandomized observational design, small sample size, and unequal gender ratio. About 75% of all participants were female. A literature evaluation table is provided in the appendix.
Applicable change or nursing theory utilized
In this capstone change project, Kurt Lewin’s change model will be used to implement the proposed change. This change theory has three stages unfreezing, change, and freezing. Using this theory, the unfreezing stage represents a time when stakeholders receive information regarding the project (Hussain et al., 2018). Here, the researchers and those responsible will try to find means to help people let go of an old pattern of practice.
This stage can be achieved in three ways. One is by increasing the driving forces that keep behavior away from the status quo. Two is to reduce the barriers that hinder migration from the existing practice. The third one involves a combination of the two methods (Hussain et al., 2018). People will naturally resist the change; therefore, it is necessary to create awareness about how the status quo is hindering the facility from achieving its goals.
The second stage changes, which involves a process of change in behavior, thoughts, and feeling, that in some way are more productive. In this study, this would mean healthcare professionals beginning to adopt the change to meet the project goals (Hussain et al., 2018). The third phase is refreezing which establishes the change as a new clinical practice that now becomes the standard operating procedure. This means patient or community education regarding diabetes and healthy lifestyle changes.
Proposed implementation plan with outcome measures
This study will involve educating patients without diabetes, with prediabetes, and people diagnosed with diabetes who come from high-prevalence areas. These individuals must be adults aged 18 years and above. Both males and females will be recruited. Participants will be briefed about the study and a consent form will be provided Purposive sampling will be used to recruit the right people for the study (Rafie et al., 2021). Before administering the educational programs, patients will use questionnaires to test their knowledge regarding diabetes and lifestyle behaviors.
Another set of questionnaires will be provided after the training to assess knowledge. These patients will be