| Course | DNP 751 DNP Applied Project II (DNP/751) |
|---|---|
| Week | 3 |
| Paper type | Framework chapter |
| Length | about 1,242 words, 5 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 3
Why a Distress Screen Should Lead to Different Responses, and How the Change Will Take Hold: Stress and Coping Theory With the Iowa Model and Its Sustainability Framework
[Student Name]
University of Phoenix
DNP/751: DNP Applied Project II
Week 3 Assignment: Proposal Section 3 Draft
[Instructor Name]
[Date]
The health center and staff are composites written for a model paper.
Two Questions, Two Frameworks
A proposal to screen for diabetes distress must explain two things. The first is clinical: why distress looks different from one patient to the next and why a single response, such as a referral for counseling, will not fit everyone. The second is organizational: how a new routine will be introduced into a busy clinic and still be running a year later. A theory of stress and coping answers the first question. The revised Iowa Model, with its companion framework for implementation strategies, answers the second.
The Transactional Model of Stress and Coping
Lazarus and Folkman (1984) described stress as a transaction between a person and the environment, shaped by two kinds of judgment. In primary appraisal, the person judges whether a demand matters and whether it threatens harm or loss or offers a challenge. In secondary appraisal, the person judges whether they have the resources to meet it. Stress arises when demands are appraised as exceeding resources. Coping then follows two broad paths: problem-focused coping, which acts on the demand itself, and emotion-focused coping, which aims to ease the distress the demand stirs up. At the heart of the model is the idea that one demand may overwhelm one person yet feel manageable to another, because appraisal and resources differ.
Applying the Model to Diabetes Distress
Living with type 2 diabetes presents a steady stream of demands: checking glucose, adjusting food, taking medicines, attending visits and facing the prospect of complications. The four subscales of the Diabetes Distress Scale (Polonsky et al., 2005) can be read as distinct appraisals. Regimen-related distress reflects a secondary appraisal that one lacks the skills or energy to keep up with treatment. Emotional burden reflects a primary appraisal of threat, the sense of being overwhelmed. Physician-related distress reflects an appraisal that a key resource, the clinician, is not available or trusted. Interpersonal distress reflects an appraisal that family and friends are not a source of support.
If distress comes from different appraisals, then the response must fit the appraisal: a patient who feels unable to manage the regimen needs problem-focused help to make it manageable, while a patient overwhelmed by fear needs support aimed at the emotion itself. This reasoning underlies the project's pathway. Care managers will read subscale scores and choose problem-solving support for regimen distress, a review of goals and communication with the clinician for physician-related distress, family or peer resources for interpersonal distress, and, when emotional burden is high, an in-person introduction to the site's behavioral health consultant. Evidence supports the logic: in a distress trial, reductions in regimen distress tracked with better adherence and glycemic control (Hessler et al., 2014).
The Revised Iowa Model as the Project Roadmap
Members of the Iowa Model Collaborative (2017) revised the Iowa Model of Evidence-Based Practice after surveying clinicians who had used it. The revised model moves through identifying a trigger, stating a purpose, confirming priority, forming a team, gathering and appraising evidence, piloting, deciding on adoption, integrating and sustaining the change, and disseminating results, with decision points that can send a team back a step. In this project, the trigger and priority phases are complete, the team is formed and the evidence has been appraised. The proposal itself prepares the pilot phase, and DNP 752 will carry out the pilot, the adoption decision and dissemination.
Choosing Strategies With the Sustainability Framework
The Iowa Model says what to do but not which strategies make each phase succeed. Cullen et al. (2022) developed the Iowa Implementation for Sustainability Framework to fill that gap. Working from implementation literature and experience with the Iowa Model, they specified 75 implementation strategies arranged in four phases, from creating awareness and interest, to building knowledge and commitment, to promoting action and adoption, to pursuing integration and sustained use. In their survey of users, most rated the framework useful and generalizable. The project selects strategies from each phase. To create awareness, the project lead will present site data on distress at a staff meeting and share a patient story with permission. To build knowledge and commitment, medical assistants and care managers will receive brief training with role play, and a medical assistant champion will be named. To promote action, the tablet form will prompt the full scale automatically, and the latest run charts will hang in the staff room each Monday. To pursue integration, the workflow will be written into the site's rooming protocol and the report added to the monthly quality dashboard.
Plan-Do-Study-Act Within the Pilot
Inside the pilot phase, Plan-Do-Study-Act cycles will refine the workflow step by step. A review of published PDSA work by Taylor et al. (2014) found that many teams skipped the features that make the method useful, such as linked cycles and frequent data, so each cycle here will begin from the last one's findings and use weekly counts.
Concept Map in Words
The concept map places the patient's appraisal of diabetes demands at the left, feeding into distress measured by the scale and its subscales. From each subscale an arrow leads to a matched care manager response, and from the responses arrows lead to the outcomes: reduced distress and, in the longer term, better adherence. Around this clinical chain sits the Iowa Model, with its pilot and adoption phases shown as a frame, and the sustainability framework's four phases shown as the strategies that keep the frame in place.
Why Not Another Theory
Two alternatives were considered. The health belief model accounts for health actions by weighing how susceptible people feel, how serious they judge the threat, and the benefits and barriers they see, and it could frame why patients do or do not follow a regimen. It says little, however, about emotional burden or about the relationship with the clinician, both of which the distress scale measures. Self-determination theory, which centers on autonomy, competence and relatedness, fits the regimen and interpersonal subscales well and has a strong diabetes literature, but it offers less guidance on the sense of threat that drives emotional burden. The transactional model covers all four subscales through a single mechanism, appraisal of demands against resources, which is why it was chosen.
Limits of the Theory in This Project
The stress and coping model describes a process inside the patient, and the project cannot measure appraisals directly; it infers them from subscale scores. The model also treats coping as something a person chooses, when many of the demands facing the site's patients, such as the cost of supplies or unpredictable work hours, are structural. The pathway acknowledges this by including referral to the health center's community health worker for social needs, which the stress model alone would not suggest.
How the Frameworks Will Be Evaluated
The theory will be tested indirectly by examining whether subscale-matched responses are used as intended and whether scores fall most in the subscale that was targeted. The implementation frameworks will be evaluated through fidelity to the planned strategies and through staff ratings of acceptability and feasibility.
Summary
Stress and coping theory explains why distress differs between patients and why responses should be matched to its source. The revised Iowa Model sets the phases of the project, and the sustainability framework supplies named strategies for each phase. The next section describes the project's methodology and design.
References
Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa Implementation for Sustainability Framework. Implementation Science, 17, Article 1. https://doi.org/10.1186/s13012-021-01157-5
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
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
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer.
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
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862
What the DNP 751 Week 3 instructions ask
In DNP 751 Week 3, most prompts ask students to develop the theoretical or translational framework section of the proposal in depth. Students describe the chosen theory or framework and its origins, define its main concepts, explain how each concept applies to the project, and show how the framework will guide implementation and evaluation. Many sections expect two layers: a theory that explains the phenomenon, such as a nursing or behavioral theory, and a translational or implementation framework that guides the practice change. A concept map or diagram is often requested. The section is typically five to eight pages in the proposal. Faculty check that the framework is used rather than only named, and that its concepts appear again in the methods and evaluation.
How this DNP 751 Week 3 example is built
The chapter opens by explaining why the project needs two kinds of framework. The first part presents the transactional model of stress and coping, its concepts of primary appraisal, secondary appraisal and problem-focused and emotion-focused coping, and applies each to a patient with diabetes, showing how the four subscales of the distress scale map onto different appraisals. That mapping becomes the logic for matching care manager responses to subscale scores. The second part applies the revised Iowa Model's phases to the project, and the third selects implementation strategies from the Iowa sustainability framework's four phases, from building awareness to sustained use. A concept map described in prose links the theory, the model and the measures, and a closing section explains how the frameworks will be evaluated.
DNP 751 Week 3 grading rubric: where the points go
For a framework chapter, rubrics usually give the most weight to application: each concept defined, linked to the project with specific examples and carried into the methods and evaluation. Faculty also assess the fit between the chosen theory and the clinical problem, the accuracy of the description drawn from primary sources, and the logic of combining frameworks. A concept map or model diagram is often scored separately for clarity. Scholarly writing, integration of feedback from earlier drafts and APA format make up the rest. Chapters that devote pages to a theorist's biography and a paragraph to application usually lose points, while chapters that show how each concept changes a decision in the project tend to score well.
DNP 751 Week 3 help: mistakes to avoid
A common problem in DNP 751 Week 3 is naming a theory because it is familiar rather than because it explains the problem. Choose a theory whose concepts map onto your project, then show the mapping. Another mistake is confusing a theory with an implementation framework; one explains why the problem occurs or why the intervention should work, the other guides how the change is introduced. Students often forget to carry the framework forward, so the methods never mention it again; name the concept that each measure or step reflects. Use primary sources for each theory, and cite the current version of any model that has been revised. Finally, keep the concept map simple enough to read, with arrows that mean something specific.
Related DNP 751 sample papers
Other DNP 751 week samples
- DNP 751 Week 1: Revised Introduction and Problem
- DNP 751 Week 2: Literature Review Synthesis
- 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 3 questions, answered
What does DNP/751 Week 3 usually ask for?
Many sections ask students to develop the theoretical or translational framework section of the DNP applied project proposal, defining concepts, applying them to the project and showing how they guide implementation and evaluation.
Where can I find a free DNP 751 Week 3 sample paper?
The framework chapter posted above is free, complete and annotated, pairing stress and coping theory with the Iowa Model. A first custom chapter built on your own theory can be requested without charge.
Does a DNP project need both a theory and a framework?
Many programs expect both: a theory that explains the problem or why the intervention should work, and a translational or implementation framework that guides putting the change into practice.
What is the transactional model of stress and coping?
Developed by Lazarus and Folkman, it holds that stress depends on how a person appraises a demand and their resources to meet it, and that coping may aim at the problem itself or at the emotions it causes.
What is the Iowa Implementation for Sustainability Framework?
It is a companion to the Iowa Model that names 75 implementation strategies across four phases and ten domains, from creating awareness to sustaining use, so teams can choose strategies for each stage of a change.
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