NRS 490 Capstone Project Change Proposal Sample

Shared Medical Appointments with Registered Nurse for Better AIC Control in Diabetes


Diabetes described as a complex, chronic illness that requires tight glycemic control to prevent risk factors associated with Diabetes. There is evidence of tighter glycemic control helping reduce risks associated with diabetes like vascular damage and organs failure. The chronic hyperglycemia associated with long-term damage, dysfunctional organs and potential organs failure. Uncontrolled diabetes affects the eyes, kidneys, the heart, nerves, and blood vessels (American Diabetes Association, 2014: S83).

The growing incidences of diabetes without a comparable level of care and glycemic control exposes individuals to the risk factors associated with diabetes. However, research on lifestyle interventions has demonstrated delayed onset of diabetes-related risks with people with impaired glucose tolerance (Chen, 2018: 13). This paper aims to validate the effect of consistent medical intervention exploring the mediating role of the registered nurse. The PICOT study shades light using empirical evidence.

Problem Statement of PICOT Study

Diabetes has persistent being a health concern globally despite improvement in treatment and growing knowledge in its management. The prevalence of non – communicable diseases is on the rise with 19 million mortality associated with cardiovascular diseases; diabetes is remaining a significant contributor (Vakili et al., 2015). Globally 1.7 billion people are overweight with a substantial 315 million being obese. The population with type 2 diabetes estimated at 250 million people and the number is projected to increase to 400 million by 2025 according to Marseglia et al. (2016).

PICOT Question:  

  1. An increased glucose level is independently related to an increased A1C level. Does reducing the A1C levels with specialized teaching from the nurse, practitioners, and dieticians help to control diabetes on adult patients?
  2. Do shared medical appointments improve glycemic control through Registered Nurse Mediation?


The populations for the study are American adult patients diagnosed for type 2 diabetes, aging 40 to 60 years old. This population is heterogeneous concerning co-morbidities and general health status, which is essential to establishing the appropriate intervention.


The proposed intervention involves active Registered Nurses involvement in assisting patients with type 2 Diabetes keep appointments, observe strict adherence to medications, dietary and other recommendations. The nurse would help monitor record keeping with regard to fasting blood sugars, time of taking medication in the 12 weeks during the study. The study will note the essential parameters like blood sugar, weight, and other vital measurements at the beginning of the study and the end of the study.


To determine whether the intervention is successful; A1C levels would be measured before and after the changes in lifestyle and diet.


At the end of the study, it is expected that the A1C levels of adult diabetic patients that adhere to study recommendations would reduce.


The research proposed to take 12 weeks.

PICOT Purpose Statement

Control of type 2 diabetes for American newly diagnosed adult patients has been problematic (P) due to the poor lifestyle and diet, which leads to an increased glucose level. Specialized teaching from the nurse, practitioners, and dieticians is an effective strategy to make the patients live appropriately by eating the right food and doing exercises (I), which can enable them to control their A1C levels (C) and live the normal life (O) within 12 weeks (T).

Education as regards to lifestyle modifications has been proved to be an effective intervention for controlling type 2 diabetes. Kuo et al. (2015) indicate that lifestyle interventions such as regular exercises and diet changes reduce the incidence of diabetes by 53 percent compared to the control group. People assigned to these interventions reported reduced A1C levels than the control group. In a similar study by Islam et al. (2014), changing the lifestyle plays a crucial role in reducing the glucose levels, which further minimizes the cases of diabetes by 27 percent.

Hence, there is an essential relationship between increased glucose level and increased A1C level as well as the lifestyle change and reduced A1C levels, which leads to effective control of diabetes. Among patients with pre-diabetes, it is worth to control their diet and do regular exercises to help in a decrease of diabetes occurrence. Failure to prevent diabetes means increased mortality. It is, therefore, the responsibility of each person to ensure they are living a healthy life to lower the risk of diabetes.

Literature Review

There is evidence of the efficacy of oral anti-glycemic agents in controlling diabetes. In the PICOT statement, do socioeconomic factors, biochemical characteristics and oral medications relate to the complications of diabetes? This question aims at investigating the clinical features of patients with type 2diabetes on oral drugs and determines the complications and risk factors in the patients. (Islam, 2014:7). Does uncontrolled diabetes affect cognitive function-a predisposition to dementia? This other research question aims at finding out the effect of uncontrolled diabetes on the risk of dementia. (Marseglia, 2016:1072)

Is there a difference in cost between Nursing practitioners and primary care physicians? This research question aims at investigating if there is a difference in cost and level of care between Nursing practitioners and primary care physicians. It also consists of an explored eye examination, cholesterol, HbA1C, neuropathy, referrals, and costs between Nursing practitioners and Primary physicians (Kuo, 2015:1982). Does medication adherence have any effect on glycemic control among diabetic patients? This research question aims at looking at the quantitative study of medication in relevance to diabetic patients. (Almadhoun, 2018:3).

The research questions relate closely with the aim of finding out more information and statistics about diabetes and the precautions that can be taken to prevent its development. My capstone project research question; does diabetes nursing visits and improving A1C levels to the required status over 12 weeks help control diabetes? This question aims at finding out if regular visits of the patients by nursing practitioners and improving their A1C levels will help control diabetes.

Theory of Planned Behavior

The PICOT study is grounded in the theory of planned behavior advanced by Ajzen (1991). The approach has been used in many fields to explain behavior and intentions. The approach is relevant in the current study because there are aspects of patients desiring health that can be achieved through lifestyle modification, adhering to medication treatment protocols and exercising. The motivation to modifying lifestyle is triggered to avert risks associated with uncontrolled diabetes.

Implementation plan

The study will recruit 20 types 2 diabetic patients with uncontrolled diabetes, ten male and ten female between the ages of 40-60 years. The respondents’ vital data will be collected at the beginning of the intervention and monitored over twelve weeks and at the end of the study. The data will then be analyzed to determine the effect of registered nurses in facilitating adherence to treatment and lifestyle modifications by the study respondents as suggested by physicians, dieticians, and pharmacists. The intervention plan is a multi-dimensional and holistic to determine the mediating role of the registered nurse influence in diabetes control.

Potential Barriers to the Intervention

There are inherent limitations to the PICOT study; first, the respondents may drop-off during follow-up thus affecting the survey. Secondly, the study sample size may be too small to allow generalization. Thirdly, there is the possibility of data interference reducing reliability and validity of the study. Lastly, the follow-up period may be too short to experience a remarkable change in outcome. The limitations were overcome by the nurse taking leadership in communicating and creating professional relationships with the respondents. Calls were made in advance to confirm clinic days, reminder respondents to take medication and adhere to the study protocol.


In conclusion, as evident in the article, there have been various research projects that offer factual support to the PICOT study. Research projects are relatable in a way that they aim at finding out the best applicable methods of controlling diabetes and AIC levels.

There are reports and research findings that contribute to providing more information on the control and management of diabetes. These include; Effect of Uncontrolled Hyperglycemia on levels of Adhesion Molecules in Patient with Diabetic Mellitus Type 2 and the effects of health mentoring program in community-dwelling vulnerable elderly individuals with diabetes. The proposed PICOT study will illuminate the possible mediating role of the Registered Nurse in improving the treatment and management of type 2 Diabetes. The results from the PICOT study demonstrate that the part of the nurse is vital is achieving tighter glycemic control. All cases except one recorded a real reduction in AIC.


  • Almadhoun, M.R (2018) Journal of Clinical and Experimental pharmacology 8 (3), pp.1-10
  • American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care37(Supplement 1), S81-S90. DOI:10.4172/2161-1459.1000250
  • Gong, Q., Zhang, P., Wang, J., Ma, J., An, Y., Chen, Y. & Chen, Y. (2018). Reducing Morbidity and Mortality in Type 2 Diabetes by Lifestyle Intervention: 30-Year Follow-Up of the Da Qing Diabetes Prevention Study.
  • Islam, S.M.S., Alam, D.S., & Wahiduzzaman, M., Nielsen, L.W, Fresch, G., Ferrari, U, Seisoler, J, Rouf, H, M.A & Lechner, A. (2014). Clinical Characteristics and Complications of Patients with Type 2 Diabetes Attending an Urban Hospital in Bangladesh. Diabetes and Metabolic Syndrome: Clinical Research Reviews, 1-7
  • Kuo, Y., Goodwin, J.S. & Chen, N. Lwin, K.K., Baillargeon, J., & Raji, M.A. (2015). Diabetes Mellitus Care Providers by Nurse Practitioners versus Primary Care Physicians, Journal of American Geriatric Society. 63 (10), 1980-1988
  • Marseglia, A., Fratigioni, L., Laukka, E.J., Santoni, G., Pedersen, J., Backman, L. & Xu, W. (2016). Early Cognitive Deficits in Type 2 Diabetes A Population-Based Study. Journal of Alzheimer Disease. 53, 1069-1078
  • Ruszkowska-Giastek, B., Sollup, A., Wernik, T., Rupiecht, Z., Golalczkyk, K., Gadomska, G. & Rosc, D. (2015). Effect of Uncontrolled Hyperglycemia on levels of Adhesion Molecules in Patient with Diabetic Mellitus Type 2. Zhejiang University- Science (Biomedical and Biotechnology) 16 (5), 355-361