DNP 750 Week 8 The Complete DNP Applied Project Precis Example

Naming the Weight of Diabetes: A Precis for a Nurse-Led Diabetes Distress Screening and Follow-Up Project in Safety-Net Primary Care

[Student Name]

University of Phoenix

DNP/750: DNP Applied Project I

Week 8 Assignment: DNP Applied Project Precis

[Instructor Name]

[Date]

The health center, staff and figures are composites written for a model paper.

Abstract

Patients with type 2 diabetes at a single safety-net clinic are screened annually for depression but never for diabetes distress, the emotional burden of managing the disease, which affects about a third of this population and is linked with glycemic control. This quality improvement project will add a two-item distress screen to diabetes visits, give the 17-item Diabetes Distress Scale to patients who screen positive, and route them to registered nurse care manager follow-up matched to the type of distress. Over 12 weeks the project will measure the screening rate, timely follow-up and change in distress scores, guided by the Iowa Model and Plan-Do-Study-Act cycles.

Problem and Significance

Diabetes distress is distinct from depression. In a longitudinal analysis, distress rather than depression tracked with A1C (Fisher et al., 2010), and a meta-analysis of 55 studies put its prevalence in type 2 diabetes at 36% (Perrin et al., 2017). National standards call for routinely checking for distress, above all in patients who are not reaching their treatment goals (American Diabetes Association Professional Practice Committee, 2025). At the project site, 820 adults have type 2 diabetes, 41% have a most recent A1C above 9%, depression screening reaches 93% of them and distress screening reaches none. A two-week log by the care managers recorded 19 unprompted expressions of diabetes-related frustration or exhaustion with no place to document or act on them.

Purpose and Practice Question

The project sets out to make distress screening, with defined follow-up, a routine part of diabetes visits at the site and to evaluate its effect on identification, timely follow-up and distress over 12 weeks. In compact form, the question asks whether, for the site's adult patients with type 2 diabetes, adding the two-item screen, with the full scale and care manager follow-up for positive results, raises the share of visits that include a distress screen and the share of positive screens reached within two weeks, and lowers distress among those patients, when compared with depression screening alone across 12 weeks.

Evidence Base

The evidence supports each link in the intervention. The 17-item scale has a stable four-domain structure and good reliability (Polonsky et al., 2005). The DDS2 detects at least moderate distress with high sensitivity and acceptable specificity (Fisher et al., 2008), and mean item scores of 2.0 and 3.0 mark moderate and high distress (Fisher et al., 2012). In a pragmatic trial, structured interventions reduced distress in all arms, with the largest gains for high regimen distress when distress was addressed directly (Fisher et al., 2013). Care management is among the quality improvement strategies shown to improve diabetes outcomes (Tricco et al., 2012).

Framework

The revised Iowa Model (Iowa Model Collaborative, 2017) guides the project from trigger to dissemination; its steps for piloting a change and then deciding on adoption suit a project confined to one site. Plan-Do-Study-Act cycles will test workflow changes during the pilot, with at least three cycles planned, each starting from a written prediction and judged on weekly data.

Design and Setting

The design is a single-site quality improvement project comparing 12 weeks of baseline with 12 weeks of implementation, using run charts for process measures and a paired comparison for distress. Roughly 6,400 adults use the site each year; most have Medicaid or no coverage, and 14% prefer Spanish. Medical assistants room patients with tablets, two care managers follow high-risk patients and a behavioral health consultant takes same-day handoffs.

Methods and Measures

Medical assistants will offer the DDS2 at rooming for eligible visits. A mean score of 3 or more prompts the full scale; the care manager reviews subscales the same day and makes contact in clinic or by phone within 14 days, choosing a response by domain, from problem-solving support to a warm handoff for high emotional burden. Four measures answer the question: eligible visits screened, positive screens followed up within 14 days, change in mean distress score at 12 weeks among positives, and minutes added to rooming as a balancing measure. A1C will be reported descriptively as an exploratory measure. Weekly de-identified reports from the electronic health record will feed run charts read with standard shift and trend rules, and each patient's paired distress scores will be tested for change.

Ethics and Approvals

The project implements validated tools under a national standard with minimal added burden, which places it within quality improvement as described by Lynn et al. (2007); the health center's quality committee and the university's DNP project committee will make the formal determination. Screening is voluntary, Spanish versions will be used, reports will be aggregate, and any positive answer on the PHQ-9 self-harm item triggers the site's same-day crisis policy. The medical director's letter of support is signed; the operations approval for staff time will follow the proposal.

Anticipated Barriers

Three barriers are most likely. Medical assistant turnover could interrupt screening, so the medical assistant champion will train each new hire during orientation and the first improvement cycle will test the workflow with a single assistant before it spreads. Care manager capacity could be exceeded if more patients screen positive than the one in three expected; follow-up will then be ordered by subscale level, with high emotional burden first. Delays in the form build could push back the start, so paper versions of both instruments are prepared as a fallback, with scores entered weekly by the champion.

Deliverables for DNP 751 and DNP 752

The proposal course will produce a full proposal with an expanded literature review, a framework chapter, detailed methods and an evaluation plan, along with the site's quality improvement determination and the university's approval. The final course will produce the implementation report with run charts and paired results, a manuscript prepared to SQUIRE 2.0 standards, a poster for the health center's annual quality fair and a two-page summary for the medical director to support the adoption decision.

Timeline

DNP 751: full proposal, determinations, electronic health record build, Spanish instruments reviewed and staff trained. DNP 752: 12-week pilot with three improvement cycles, analysis, final manuscript and poster, then a report to the quality committee.

Expected Outcomes

The project expects at least 80% of eligible visits to include a screen, at least 85% of positive screens to receive timely follow-up and a measurable decline in distress among positives, with rooming time increasing by no more than two minutes. If these targets are met, the medical director will consider adoption at the other two sites.

Contribution to Practice

The project draws on the doctoral Essentials by translating evidence into a practice change, leading an interprofessional team, using clinical data to evaluate care and addressing a gap that affects patients at a safety-net site. It also gives the health center a tested workflow and data it can use in its grant reporting, whatever the adoption decision turns out to be.

Conclusion

This precis sets out a focused, feasible project that answers a clear gap between evidence and practice. It is ready for development into a full proposal in DNP 751.

References

American Diabetes Association Professional Practice Committee. (2025). 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of care in diabetes 2025. Diabetes Care, 48(Suppl. 1), S86-S127. https://doi.org/10.2337/dc25-S005

Fisher, L., Glasgow, R. E., Mullan, J. T., Skaff, M. M., & Polonsky, W. H. (2008). Development of a brief diabetes distress screening instrument. Annals of Family Medicine, 6(3), 246-252. https://doi.org/10.1370/afm.842

Fisher, L., Hessler, D., Glasgow, R. E., Arean, P. A., Masharani, U., Naranjo, D., & Strycker, L. A. (2013). REDEEM: A pragmatic trial to reduce diabetes distress. Diabetes Care, 36(9), 2551-2558. https://doi.org/10.2337/dc12-2493

Fisher, L., Hessler, D. M., Polonsky, W. H., & Mullan, J. (2012). When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale. Diabetes Care, 35(2), 259-264. https://doi.org/10.2337/dc11-1572

Fisher, L., Mullan, J. T., Arean, P., Glasgow, R. E., Hessler, D., & Masharani, U. (2010). Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care, 33(1), 23-28. https://doi.org/10.2337/dc09-1238

Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

Lynn, J., Baily, M. A., Bottrell, M., Jennings, B., Levine, R. J., Davidoff, F., Casarett, D., Corrigan, J., Fox, E., Wynia, M. K., Agich, G. J., O'Kane, M., Speroff, T., Schyve, P., Batalden, P., Tunis, S., Berlinger, N., Cronenwett, L., Fitzmaurice, J. M., ... James, B. (2007). The ethics of using quality improvement methods in health care. Annals of Internal Medicine, 146(9), 666-673. https://doi.org/10.7326/0003-4819-146-9-200705010-00155

Perrin, N. E., Davies, M. J., Robertson, N., Snoek, F. J., & Khunti, K. (2017). The prevalence of diabetes-specific emotional distress in people with type 2 diabetes: A systematic review and meta-analysis. Diabetic Medicine, 34(11), 1508-1520. https://doi.org/10.1111/dme.13448

Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J., & Jackson, R. A. (2005). Assessing psychosocial distress in diabetes: Development of the Diabetes Distress Scale. Diabetes Care, 28(3), 626-631. https://doi.org/10.2337/diacare.28.3.626

Tricco, A. C., Ivers, N. M., Grimshaw, J. M., Moher, D., Turner, L., Galipeau, J., Halperin, I., Vachon, B., Ramsay, T., Manns, B., Tonelli, M., & Shojania, K. (2012). Effectiveness of quality improvement strategies on the management of diabetes: A systematic review and meta-analysis. The Lancet, 379(9833), 2252-2261. https://doi.org/10.1016/S0140-6736(12)60480-2