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The DNP Project: Implementation


PICOT: “In adult patients with diabetes in a primary care outpatient setting, will implementation of the DSMES program, compared to current practice, impact fasting blood sugar within 8-10 weeks?”
1- How you are going to ensure achievement of these milestones?
 The change project will comply with the Plan-Do-Study-Act (PDSA) cycle model. These steps require nurses to plan their change, implement it, assess its impact, and sustain it. The implementation schedule will take nine weeks, which should involve educating diabetic patients using the DSMES program before the evaluation in the last week. The change process has four milestones, and the educational intervention has ten milestones. The change process milestones will be achieved systematically, beginning with the planning stage to the action stage. According to Coury et al. (2017), the planning stage usually involves preparing for change by having necessary stakeholders, creating the project’s aim, and having the needed resources. Therefore, all the stakeholders and resources, such as nurses, diabetic patients, and educational materials, including the objectives to be addressed, should be drafted before proceeding to the implementation stage. The implementation stage should be feasible if the resources in the planning stage are availed. The analysis is always done based on the results of the actions (Coury et al., 2017). Thus, it can be convenient if the ‘Do’ stage is well done. Finally, an action is taken based on the outcomes of the study stage (Coury et al., 2017). In this case, it will be done when the action stage is complete. As for the implementation, preparatory analysis of the DSMES topics before each week can facilitate the completion of the educational intervention. Overall, the change process and implementation milestones can only be achieved well when adequate preparation is done during the planning stage, including ensuring that patients, nurses, and educational materials are available before the project.
2-How has your plan for implementation changed, if at all?
            The implementation plan changed to ensure that each subtopic of the DSMES program is taught each day. For instance, the program has various topics, including drug adherence, healthy nutrition, diabetes management, and physical activity (Goff et al., 2021). Each topic will be tackled each day to ensure that patients understand everything by the end of the educational program.
3-Why were these changes necessary?
           These changes were necessary since patients would forget the information and fail to comply. According to Naylor and Torres (2019), learning objectives are significant as they help students learn what they should do and can assist in designing more effective instruction. In this project, designing more effective instruction using the general DSMES program would be unfeasible. For this reason, each topic was selected to create a more practical learning program. For instance, when learning about nutrition, patients will understand different foods and their significance in controlling blood sugar. When learning about physical activity, they will be taught moderate exercises and instances where they may need vigorous physical activity. Overall, changes were necessary to make the educational process convenient.
4-Have you started implementation?
           I am yet to start the implementation since I have just finished organizing the stakeholders. The DSMES program is effective when implemented by nurses (Kashani et al., 2020). Thus, I have worked on getting nurses who will educate patients. I am set to begin the implementation process the next week. With the availability of the stakeholders, the process will be completed well.
Successes, Challenges, or Barriers
           The implementation process is currently in the first stage of reorganizing resources. I have identified all the resources needed to be utilized in the project. The success was getting nurses willing to educate patients since nurses efficiently deliver patient education (Fereidouni et al., 2019). The only challenge was getting all patients to agree since some withdrew from the project, and I had to replace them. The language barrier was the only barrier witnessed while engaging patients. Overall, the project is set to begin since all the resources are available.
Coury, J., Schneider, J. L., Rivelli, J. S., Petrik, A. F., Seibel, E., D’Agostini, B., Taplin, S. H., Green, B. B., & Coronado, G. D. (2017). Applying the plan-do-study-act (PDSA) approach to a large pragmatic study involving safety net clinics. BMC Health Services Research, 17(1), 411. https://doi.org/10.1186/s12913-017-2364-3 (Links to an external site.)
Fereidouni, Z., Sabet Sarvestani, R., Hariri, G., Kuhpaye, S. A., Amirkhani, M., & Kalyani, M. N. (2019). Moving into action: The master key to patient education. The Journal of Nursing Research: JNR, 27(1), 1–8. https://doi.org/10.1097/jnr.0000000000000280 (Links to an external site.)
Goff, L. M., Rivas, C., Moore, A., Beckley-Hoelscher, N., Reid, F., & Harding, S. (2021). Healthy eating and active lifestyles for diabetes (HEAL-D), a culturally tailored self-management education and support program for type 2 diabetes in black-British adults: A randomized controlled feasibility trial. BMJ Open Diabetes Research & Care, 9(1), e002438. https://doi.org/10.1136/bmjdrc-2021-002438 (Links to an external site.)
Kashani, F., Abazari, P., & Haghani, F. (2020). Challenges and strategies of needs assessment implementing in diabetes self-management education in Iran: A qualitative study. Iranian Journal of Nursing and Midwifery Research, 25(5), 437–443. https://doi.org/10.4103/ijnmr.IJNMR_10_20 (Links to an external site.)
Naylor, K. A., & Torres, K. C. (2019). Translation of learning objectives in medical education using high-and low-fidelity simulation: Learners’ perspectives. Journal of Taibah University Medical Sciences, 14(6), 481–487. https://doi.org/10.1016/j.jtumed.2019.10.006 (Links to an external site.)
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., Maryniuk, M. D., Siminerio, L., & Vivian, E. (2016). Diabetes self-management education and support in type 2 diabetes: A joint position statement of the american diabetes association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clinical Diabetes, 34(2), 70–80. https://doi.org/10.2337/diaclin.34.2.70
 Can you share your experience with your stakeholders? How did this kick off go? 


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