NURS FPX 9030 Assessment 2 Data and Data Analysis

Student Name

Capella University

NURS-FPX9030: Doctor of Nursing Practice Across the Lifespan III

Professor Name

Submission Date

Introduction

Diabetes mellitus type 2 continues to be one of the most common chronic diseases that is managed in outpatient primary care. Considering the selected site as an outpatient primary care center in New Jersey suburban region, 450 adult patients diagnosed with diabetes mellitus Type 2 are identified within a period of six months with an average site fasting blood glucose of 145mg/dl compared to the recommended American Diabetes Association (ADA) target value of less than 100mg/dl (American Diabetes Association 2023; Nurse Manager, personal communication, October 10, 2025). Electronic health records (EHR) data review and executive communication proved the absence of a diabetes self-management education and support (DSMES) program that complies with the ADA guidelines at the site, which led to ongoing deficits related to self-care, compliance, and control of the disease. The evidence given by the literature supported the gap, leading to nearly half of adults with diabetes reaching glycemic goals due to the lack of self-management support (Centers for Disease Control and Prevention, 2024). In order to bridge the practice gap, a 12-week quality improvement (QI) project will be designed with the following population, intervention, comparison, outcome and timeframe (PICOT) question: How implementing DSMES, as recommended by the ADA (I), compared to current practices (C) affects fasting glucose levels (O) in 12 weeks (T) in nursing staff working with adult patients with Type 2 diabetes (P)? The project aimed to identify the effectiveness of an ADA-compliant DSMES program on glycemic indicators, behavior change, self-efficacy, and competence of nursing professionals. The results clearly showed that there was a significant improvement in all the outcome indicators during the 12 weeks of implementing the intervention.

Project Design and Data Collection

The pre-post quality improvement design was used to implement the intervention that would identify the effects of the structured DSMES intervention on 45 adults with Type 2 diabetes visiting the clinic, and individual data of a sub-sample of 20 respondents were collected, as well as 15 nursing professionals trained in the DSMES approach. Before the project was initiated, institutional review board (IRB) review and directions were requested and the intervention met the requirements of the QI exemption criteria and met the regulations of the health insurance portability and accountability act (HIPAA) in the entire course of the project. The identifiers of the participants were transformed into anonymous codes, where the patient group was assigned codes DM-01 to DM-20 and the nursing staff was assigned codes ST-01 to ST-15, according to the institutional policy on data confidentiality. Three time points, Baseline (week 1), Mid-point (week 6, fasting glucose only), and post-intervention (week 12), were used to collect data. Pre-post Design is an immensely popular approach for assessing the efficacy of interventions in the clinical QI context (Engelsbel et al., 2024). Point-of-care testing of blood glucose levels was realised with the help of the EHR system. The summary of diabetes self-care activities (SDSCA) scale (0-7) and validated self-efficacy scale (0-10) of diabetes were used to test self-management and self-efficacy, and both have demonstrated good content validity and change sensitivity in Type 2 patients with diabetes (Ibrahim et al., 2025; Romadlon et al., 2024). Participation of the patients in DSMES was taken using the attendance log. A weekly audit in the form of a chart review of the EHR system was used to check documentation compliance. The knowledge test of the post-pre-test training level of staff based on an ADA curriculum was used to measure staff competence with respect to a return demonstration competency test.

Data Analysis

Quantitative data were analyzed descriptively and inferentially to determine the effect of the DSMES intervention on the following outcome variables: fasting glucose levels, patient self-management, and nurse outcomes. The primary type of inferential analysis was the paired t-test, which included comparing the baseline and week 12 values of the fasting glucose level and SDSCA score and self-efficacy score of the same group of participants at two separate time points. The ideal inferential process for a pre-post QI design is a pair of tests when repeated measures of the same participants will be applied, as they address the potential of controlling differences among subjects and will be more sensitive (Chicco et al., 2025). The average level of fasting glucose in the 20-patient sample reduced to 129.6mg/dl at week 12, which corresponds to a difference of 17.6mg/dl. The patient of DM-14 has missed the week 12 evaluation, and thus the SDSCA and self-efficacy analysis on post-intervention consisted of 19 patients only. Various process measures (number of sessions attended, documentation) were easily expressed as proportions and compared with project targets. The success of training in staff was merely outlined. Visual depiction of the improvement was plotted in improvement run charts illustrating a baseline, week 6, and week 12 fasting blood glucose. The level of statistical significance was assessed considering the clinical significance and the size of the effect, according to the best practice requirements of quality improvement reports. Tables 1-7 in Appendix A show all the findings.

Project Results

The outcome measures of all outcome criteria were found to be better in 12 weeks of the DSMES intervention among the participants. There was a statistically significant difference in the mean fasting glucose levels between the starting level at 147.2mg/dl and the levels at the end of the intervention period, with a difference recorded at 17.6mg/dl. The outcome is within the project requirement of 130mg/dL as a maximum level of fasting glucose. Of 20 sampled patients, 11 individuals met the individual criterion of <130 mg/dL at week 12. The SDSCA mean score values grew from 3.07 to 5.01 (n=19), and self-efficacy mean scores rose from 5.24 to 7.21 (n=19). With respect to process criteria, 16/20 participants were able to attend three or more of four core DSMES sessions, which fits the criterion of attendance being in the 70 percent range. All the elements contained in the documentation compliance were at 75%, which is a bit lower than the project requirement of 80%. Regarding staff outcomes, the 15 nurses involved in the training had a mean increase of 31.2 percentage points (55.8 pre-training vs. 87.0 post-training) in knowledge scores. One hundred and forty-nine nurses (93.3 of 15) passed the competency test, and only ST-05 required a retake. Table 1–7 in Appendix A contains all the results.

Project Outcomes

The outcomes of this project indicate that the application of an ADA-compatible DSMES program resulted in statistically significant differences in glycemic control and addressed the PICOT question. The average reduction in fasting blood glucose of 17.6 mg/dL among the program participants is identical to the pooled average of 23.33 mg/dL of fasting blood glucose in the 108 randomized clinical trials comparing the use of DSMES to the control group in interventions of the T2DM population included in the systematic review by Romadlon et al. (2024). The project target of site-wide fasting glucose of <130 mg/dl has been achieved, and 55% of those patients who have an individual record have achieved the same. But the most hyperglycemic participants who exhibit high levels at baseline, including DM-14 (168 mg/dL) and DM-18 (170 mg/dL), have reduced by 20 mg/dL but did not achieve the goal of the project due to the ADA recommendations that individuals with more severe hyperglycemia require more than 12-week-long programs (ElSayed et al., 2023). The only participant (DM-14) in which missing Week 12 results were seen was because of absence of attendance following the initial session. The patients that had the lowest number of sessions attended showed the least changes in all of the outcome measures, which further validates the dose-response correlation between DSMES attendance and treatment outcomes as posited in the literature (Ibrahim et al., 2025). The 75% documentation compliance rate was below the 80% benchmark target, which was largely due to incomplete documentation of patients who had fewer sessions. Some of these project strengths were a high degree of staff competency attained (93.3%), attendance of the sessions above the benchmark rate, valid measuring instruments, and an ADA-approved curriculum. The constraints are the short duration of the project 12 weeks, small sample size at the individual level, and one site design.

Conclusion

The ADA-compliant DSMES program (implemented over 12 weeks) turned out to be clinically meaningful in terms of improved fasting glucose, self-management behaviors, self-efficacy among the patients, and competence of the nursing staff in the outpatient primary care setting. Although the average level of fasting glucose in the sample of the participants of the study was reduced to 129.6 mg/dL, 93.3% of the trained nursing staff became competent. Documentation compliance rates were not 80 (although the 12-week implementation period did not see the most glucose-impaired patients reach their specific targets), yet the results achieved suggest that the developed structured nurse-led DSMES program is possible.

References

American Diabetes Association. (2023). Understanding diabetes diagnosis. Diabetes.org. https://diabetes.org/about-diabetes/diagnosis

Centers for Disease Control and Prevention. (2024b, May 15). National diabetes statistics report. Cdc.gov. https://www.cdc.gov/diabetes/php/data-research/index.html

Chicco, D., Sichenze, A., & Jurman, G. (2025). A simple guide to the use of Student’s t-test, Mann-Whitney U test, Chi-squared test, and Kruskal-Wallis test in biostatistics. BioData Mining, 18(1), e56. https://doi.org/10.1186/s13040-025-00465-6 

ElSayed, N. A., Aleppo, G., Bannuru, R. R., Beverly, E. A., Bruemmer, D., Collins, B., Darville, A., Ekhlaspour, L., Hassanein, M., Hilliard, M. E., Johnson, E. L., Khunti, K., Lingvay, I., Matfin, G., McCoy, R. G., Pilla, S. J., Polsky, S., Pratley, R. E., Segal, A. R., & Stanton, R. C. (2023). Facilitating positive health behaviors and well-being to improve health outcomes: Standards of care in diabetes—2024. Diabetes Care, 47(1), 77–110. https://doi.org/10.2337/dc24-s005

Engelsbel, F., Keet, R., & Nugter, A. (2024). A pre-post study design: Evaluating the effectiveness of a new community-based integrated service model on patient outcomes. International Journal of Mental Health Systems, 18(1), e20. https://doi.org/10.1186/s13033-024-00636-8

Ibrahim, N. F., Nofal, H. A., Ali, H. T., Rafey, D. S. E., Almadani, N., Mahfouz, R., & Khodary, R. M. (2025). Enhancing self-care management in diabetic patients: A randomized controlled trial exploring the interplay of social support, self-efficacy, and empowerment. Acta Diabetologica, 62(10), 1691–1701. https://doi.org/10.1007/s00592-025-02498-z

Romadlon, D. S., Tu, Y., Chen, Y., Hasan, F., Kurniawan, R., & Chiu, H. (2024). Comparative effects of diabetes self‐management programs on type 2 diabetes clinical outcomes: A systematic review and network meta‐analysis. Diabetes/Metabolism Research and Reviews, 40(6), e3840. https://doi.org/10.1002/dmrr.3840