| Course | DNP 751 DNP Applied Project II (DNP/751) |
|---|---|
| Week | 2 |
| Paper type | Literature review synthesis |
| Length | about 1,195 words, 4 double-spaced pages plus title page and references |
| Format | APA 7 student paper |
| School | University of Phoenix |
| Program | DNP |
| Updated | September 2026 |
Free sample paper for DNP 751 Week 2
What Is Known and What Is Not: A Thematic Synthesis of Research on Detecting, Understanding and Reducing Diabetes Distress in Adults With Type 2 Diabetes
[Student Name]
University of Phoenix
DNP/751: DNP Applied Project II
Week 2 Assignment: Proposal Section 2 Draft
[Instructor Name]
[Date]
The health center is a composite written for a model paper.
Search and Organization
The review updates the precis search through September 2025 in CINAHL, PubMed and PsycINFO, adding terms for regimen distress, psychological intervention, insulin and primary care. The final set holds twelve sources: a meta-analysis of prevalence, a meta-analysis of interventions, one meta-analysis of quality improvement strategies, one pragmatic randomized trial and its secondary analysis, three cohort or cross-sectional studies, three instrument studies and one international survey. The review is organized in four themes that follow the logic of the proposed pathway: who has distress, why it matters, how to find it and what helps.
Theme 1: How Common Distress Is and Who Carries It
Across settings, distress is a routine part of living with type 2 diabetes rather than an exception. The pooled prevalence of 36% reported by Perrin et al. (2017) and the 44.6% figure from the 17-country DAWN2 survey (Nicolucci et al., 2013) differ partly because the studies used different instruments and thresholds, but both place distress among the most common psychosocial problems in diabetes care. Both sources also point to groups who carry more of it: a higher pooled prevalence where samples were mostly female or more depressed, and wide variation between countries in the survey. Treatment intensity adds to the picture. Delahanty et al. (2007) found higher distress in insulin-treated primary care patients, a difference that mostly disappeared once disease severity and the work of self-care were taken into account.
For this project, the agreement across studies supports screening everyone with type 2 diabetes rather than a selected group, while the variation suggests that local prevalence cannot be assumed and must be measured. Patients starting insulin or failing to meet targets are likely to show higher scores.
Theme 2: Distress, Depression and Outcomes
Three lines of evidence suggest that diabetes distress, more than depression, is tied to the outcomes diabetes care measures. Fisher et al. (2010) found that distress, but not major depression or depressive symptoms, was linked with A1C both at one point and in parallel change over time. Aikens (2012) separated the two in a six-month prospective study of primary care patients and found that the two predicted different things six months on, with general depressive symptoms tied to lifestyle behaviors and diabetes-related distress tied to medication adherence and A1C. Hessler et al. (2014), analyzing data from a distress-reduction trial, found that decreases in regimen distress over time were associated with better medication adherence, more physical activity and lower A1C.
The studies do not fully agree on direction. Aikens's work suggests distress precedes poorer control, whereas the Hessler analysis found no consistent prospective links, only changes moving together. The safest reading is that distress and control rise and fall together and that each may drive the other, which is enough to justify addressing distress in routine care without claiming that lowering it will by itself lower A1C. This reading shapes the project's outcomes: distress change is primary, and A1C is exploratory.
Theme 3: Measuring Distress in Practice
The measurement literature is consistent and practical. The 17-item scale has four stable subscales and strong internal consistency (Polonsky et al., 2005). A two-item screener drawn from it caught nearly all patients whose full-scale scores showed moderate or high distress (Fisher et al., 2008), and later work placed the thresholds for moderate and high distress at item averages of 2.0 and 3.0 respectively, based on where associations with A1C and self-care began to climb (Fisher et al., 2012). The main limitation across these studies is sample diversity: most participants were English-speaking and insured. For a site where 14% of patients prefer Spanish, the project will need the developers' Spanish versions and should report results by language.
Theme 4: What Reduces Distress
Intervention evidence is growing and mostly positive. In the REDEEM trial, distress fell significantly in all three arms, which compared computer-assisted self-management, that program plus a problem-solving component aimed at distress, and an educational control, and patients with high regimen distress did best with the distress-focused arm (Fisher et al., 2013). Schmidt et al. (2018) pooled nine randomized trials of psychological interventions in people with elevated distress and found a moderate pooled effect on distress (Cohen's d of 0.48), with diabetes-tailored interventions also lowering A1C while mindfulness-based ones did not. At the level of the health system, Tricco et al. (2012) found that quality improvement strategies, including case management and team changes, lowered A1C across 142 trials, with larger effects when baseline A1C was high.
The evidence agrees that structured, diabetes-specific attention reduces distress. It is less clear which component matters most; REDEEM's control arm improved almost as much as the active arms, which suggests that regular contact and attention may account for much of the benefit. For a care manager pathway, that is encouraging: the intervention does not need to be a formal therapy to help, although patients with high distress may need referral to one.
Quality of the Evidence
Rated as a body, the evidence is strongest where the project leans hardest. Detection rests on instrument studies of good quality, replicated in the cut point work and used widely since. Significance rests on two meta-analyses, a large survey and three longitudinal or cross-sectional studies whose findings point the same way despite different designs. The intervention evidence includes one high-quality pragmatic trial, a meta-analysis of randomized trials limited to people with elevated distress and a large meta-analysis of care improvement strategies. The weakest link is the step from trial settings to a busy safety-net clinic, which is exactly what a quality improvement pilot can inform.
Implications for the Pathway
The review shapes four design decisions. Screening will be offered to every adult with type 2 diabetes, not a selected group, because prevalence is high across groups. The two-item screener will be used first because of its sensitivity and brevity, with the full scale reserved for positive screens so that care managers see which domain drives the score. Follow-up responses will be matched to the subscale, with problem-solving support for regimen distress, since that domain moved most with intervention and tracked with adherence. Patients with high emotional burden, or with depressive symptoms on the PHQ-9, will be introduced in person to the behavioral health consultant before leaving, reflecting the evidence that tailored psychological care helps those with elevated distress.
Gaps in the Literature
Three gaps stand out. Routine distress screening has rarely been studied as a clinic workflow in settings like ours, and no retained study asked whether screening alone changes how often patients receive follow-up. Samples were mostly English-speaking and insured. Evidence on who should deliver follow-up, nurses, behavioral health consultants or physicians, is thin. The project addresses the first gap directly, reports results by language to begin on the second, and documents which care manager responses are used to inform the third.
Summary
The literature shows that distress is common, distinct from depression, closely linked with adherence and A1C, measurable in two items, and responsive to structured attention. The next section presents the framework that will guide putting this evidence into practice.
References
Aikens, J. E. (2012). Prospective associations between emotional distress and poor outcomes in type 2 diabetes. Diabetes Care, 35(12), 2472-2478. https://doi.org/10.2337/dc12-0181
Delahanty, L. M., Grant, R. W., Wittenberg, E., Bosch, J. L., Wexler, D. J., Cagliero, E., & Meigs, J. B. (2007). Association of diabetes-related emotional distress with diabetes treatment in primary care patients with type 2 diabetes. Diabetic Medicine, 24(1), 48-54. https://doi.org/10.1111/j.1464-5491.2007.02028.x
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
Hessler, D., Fisher, L., Glasgow, R. E., Strycker, L. A., Dickinson, L. M., Arean, P. A., & Masharani, U. (2014). Reductions in regimen distress are associated with improved management and glycemic control over time. Diabetes Care, 37(3), 617-624. https://doi.org/10.2337/dc13-0762
Nicolucci, A., Kovacs Burns, K., Holt, R. I. G., Comaschi, M., Hermanns, N., Ishii, H., Kokoszka, A., Pouwer, F., Skovlund, S. E., Stuckey, H., Tarkun, I., Vallis, M., Wens, J., & Peyrot, M. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2): Cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabetic Medicine, 30(7), 767-777. https://doi.org/10.1111/dme.12245
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
Schmidt, C. B., van Loon, B. J. P., Vergouwen, A. C. M., Snoek, F. J., & Honig, A. (2018). Systematic review and meta-analysis of psychological interventions in people with diabetes and elevated diabetes-distress. Diabetic Medicine, 35(9), 1157-1172. https://doi.org/10.1111/dme.13709
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
What the DNP 751 Week 2 instructions ask
The Week 2 assignment in DNP 751 typically asks students to develop the review of literature for the proposal. Prompts ask for an organized synthesis of current research relevant to the practice question, grouped by themes or concepts, with attention to agreements, contradictions, quality of evidence and gaps. Most sections expect a description of the search strategy, peer-reviewed sources mostly from the last five to ten years alongside seminal works, and a closing statement of how the literature supports the project. Some faculty ask for an updated evidence table as an appendix. The section usually runs eight to twelve pages in the full proposal, though weekly drafts are often shorter. Synthesis is the key word; a review that lists study after study will be returned for revision.
How this DNP 751 Week 2 example is built
The review opens with a short search statement and the four themes it will follow. Theme one draws on the DAWN2 survey, the Perrin meta-analysis and Delahanty's comparison of insulin, oral and diet treatment. Theme two compares evidence that distress, not depression, tracks with A1C, including the Aikens six-month study and the REDEEM secondary analysis linking falling regimen distress to better adherence and control. Theme three covers the full scale, the two-item screener and the cut point study. Theme four weighs the REDEEM trial against pooled evidence on psychological treatment for elevated distress and on system changes in diabetes care. Each theme ends with agreement, conflict and meaning for the project, and a gaps section closes the review.
DNP 751 Week 2 grading rubric: where the points go
Rubrics for the literature review in DNP 751 reward synthesis above all: themes that organize the evidence, comparison of findings across studies, and a clear statement of what the body of work shows. Faculty also grade the currency and quality of sources, correct reporting of findings and designs, and the identification of gaps that the project will address. Relevance to the practice question is its own criterion in many programs. Organization, transitions and headings carry weight because the review is long, and APA format, with every citation matched to a reference, completes the grade. A review that reports each study accurately but never compares them tends to earn fewer points than a slightly shorter review that argues from the evidence toward the project.
DNP 751 Week 2 help: mistakes to avoid
A frequent problem in DNP 751 Week 2 is the annotated bibliography disguised as a review: one paragraph per study, each starting with the author's name. Build paragraphs around ideas instead, and cite several studies inside each. Another mistake is avoiding conflict; where studies disagree, say so and suggest why, such as different measures or samples. Students also drift into topics outside the practice question, which lengthens the review without supporting the project. Report numbers carefully and use the design language correctly. Check the currency of sources and explain why any older study is included. Finally, end with gaps that the project can address, since the review should lead the reader to the conclusion that this project is needed.
Related DNP 751 sample papers
Other DNP 751 week samples
- DNP 751 Week 1: Revised Introduction and Problem
- DNP 751 Week 3: Theoretical Framework Chapter
- DNP 751 Week 4: Methodology and Project Design
- DNP 751 Week 5: Implementation Plan and Timeline
- DNP 751 Week 6: Evaluation and Analysis Plan
- DNP 751 Week 7: Ethics Review and QI Determination
- DNP 751 Week 8: Complete Proposal Draft
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DNP 751 Week 2 questions, answered
What does DNP/751 Week 2 usually ask for?
Many sections ask students to expand the review of literature for the DNP applied project proposal into a thematic synthesis that compares studies, weighs evidence quality and identifies gaps.
Where can I find a free DNP 751 Week 2 sample paper?
The thematic literature review above is a free, complete sample of this week's work, with notes in the margin on how each theme is built. Order a first custom review for your own topic at no cost.
How do I write a synthesis instead of a summary?
Organize by themes rather than by study, cite several studies in each paragraph, and state what they agree on, where they differ and what that means for your project.
Do psychological interventions reduce diabetes distress?
A 2018 meta-analysis of nine trials in people with elevated distress found a moderate pooled effect on distress, and diabetes-tailored interventions also lowered A1C.
How many sources should a DNP literature review have?
Programs differ, but a full proposal review commonly draws on 15 to 30 sources, chosen for relevance and quality rather than to reach a number.
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