Management and Prevention of Diabetes

Proofread and make correction from professor comment. Having problem cite in APA format
Combine all elements completed in previous weeks (Topics 1-4) into one cohesive evidence-based proposal and share the proposal with a leader in your organization. (Appropriate individuals include unit managers, department directors, clinical supervisors, charge nurses, and clinical educators.)
Obtain feedback from the leader you have selected and request verification using the Capstone Review Form. Submit the signed Capstone Review Form to 
For information on how to complete the assignment, refer to "Writing Guidelines" and the "Exemplar of Evidence-Based Practice Capstone Paper."
Include a title page, abstract, problem statement, conclusion, reference section, and appendices (if tables, graphs, surveys, diagrams, etc. are created from tools required in Topic 4).
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center
Combine all elements completed in previous weeks (Topics 1-4) into one cohesive evidence-based proposal and share the proposal with a leader in your organization. (Appropriate individuals include unit managers, department directors, clinical supervisors, charge nurses, and clinical educators.)
Obtain feedback from the leader you have selected and request verification using the Capstone Review Form. Submit the signed Capstone Review Form to 
For information on how to complete the assignment, refer to "Writing Guidelines" and the "Exemplar of Evidence-Based Practice Capstone Paper."
Include a title page, abstract, problem statement, conclusion, reference section, and appendices (if tables, graphs, surveys, diagrams, etc. are created from tools required in Topic 4).
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center
NRS-441V: Capstone Project
Exemplar of Evidence-Based Practice
Running head: SIGNIFICANCE OF EARLY ASSESSMENT AND INTERVENTION
Significance of Early Assessment and Intervention on the Diabetes Type 2 
Janet Lewis (Grand Canyon University
(NRS 441V: Professional Capstone)
Instructor: Gray
6/11/15
Within my working environment, I have witness an issue which I believed that is prevalent and continue to be growing issues in today healthcare world. Within the last 10 yrs working has a Registered Nurse, working in several different hospitals within New York City and Florida. Diabetes Management continues to be a great issue that surrounds the training and education within healthcare and healthcare professional. As more and more patients enter into the medical atmosphere with diabetes and the increasing number of serious complications that pertaining to this disease, there is a need for changes and the time is now. 
As healthcare transformed into primary care setting, the need is for education and training is needed. It is becoming evident to me that more education and training is required on this matter. Therefore I received this idea and it is what gives me the inspiration to build a proposal for change. For example , several nurses on the Medical/Surgical unit and CHF units that I worked on are knowledgably with the technical information about diabetes , but not many of them seem to understand the serious nature of this diseases and the complications it entail . Many patient are unfamiliar and not knowledge or educated enough about diseases. Many patients within my years as a nurse only seek treatment when they are experiencing serious complications. For example, an insulin pump is a tool that are use to help in their treatment of diabetes. Many nurses are not familiar with these tools. This pump is something that patients must cope with on a daily basic. 
Many nurses have never had hand –on experience with this pump and often stated “I never see this insulin pump before. I also find that patients themselves need a lot of education and teaching and how to maintained and prevent complication even with the use of their insulin pump. It would see a more effective approach that nurses and patients need training in managing diabetes. For more effective hands – on and training in diabetic management, nurses should spend a day as diabetic patient so that, they can fully understand what the illness entails. This will give nurses a well-rounded approach in diabetes management.
Many of my issues in which I observed is lack of knowledge, education, and training that patients received during their hospital stay by nurses... I also witness on hand that nurses received minimal amount of information and training in managing and treating this disease. For my proposal and project is to work and collaborated with members of health care professions and focus on education, training, prevention in managing diabetes. As a nurse I want to focus my attention on children, adult of ethnical community such as Hispanic who are struggling with diabetic lifestyle management. Young children find it difficulty that their lifestyle, diet, physical activities is different their peers. Diabetes is on concerns among children in Hispanic community. Obesity, language barrier, and lack of education are also great concerns... Simple activities such as a birthday parties quickly become unpleasant for diabetic children because cake and candy is served. Children suffering with diabetes often feel that their lifestyle changes are unfair and often blame themselves or others because they do not understand the seriousness of their disease.
Adult patient who are newly diagnosis, often have difficulty understanding this disease and the need for lifestyle changes to avoid complication. As nurses, our job is to show is to be compassionate and empathetic of these situations and be supportive to patients who are struggling. In order to be successful at this, nurses must understand what it is like to have diabetes. Walking in our patient shoes for a day pretended and managing this disease, we become more effective, efficient, valuable, competent, and helpful at our job. That why it is essential that nurses, patients, family members, and communities received the proper training, knowledge and education in managing this disease. I would therefore propose and improvement in nursing training, seminars, research, and patient centered, and evidence based practice in fighting and managing this diseases. 
As healthcare profession, we should not only focus on the technical aspect of diabetes but also the emotional, ethnic, and social aspect of this disease as well. Education, training, knowledge, and skills are the key ingredients in fighting, maintaining, preventing and manage this diseases. It is important for nurses to providing classes, training sessions, videos, computer programs and hands –on to their patients pertaining to management of this disease. With the Reform Act and healthcare transforming, it is important that nurse received the proper training and education and transcribed it into educating their patients, schools, family members, and the community about diabetes. Educating and training children and adults about preventing and managing this disease this intervention would greatly impact everyone. Managing and preventing complication of diabetes will decrease readmission, medical cost for insurance company, patients, and hospitals.
For the project, I would also like to find research which backs this proposal up. For example, research which indicates successful training programs in diabetes management and their outcomes in comparison to more traditional forms of training. I think it would also be beneficial to further explore the topic of diabetes management among children and the differences in their perspectives of diabetes in comparison to adults. Often children learned better with hand-on activities, color, and technology tool such as tablets or computer. It is very important to incorporated involve and get children active in their food preparation. It gives them a self of control and choices. These tools will help them adapt to their lifestyle changes. For adult providing them with tools, such as diabetic classes, glucose kits, diabetic support group, healthy nutrition menu, and access to web site about diabetes, Will be important in managing this disease and prevent complication for both children and adult. Therefore nurse must have the full knowledge, skills, training, and education about managing diabetes.
In conclusion as healthcare changes into primary care, patients are been treated as outpatient in clinics and advance care. The need for nurses to get the best training is now, and it is crucial in margining this diseases. With the great needs, desire, and concerns about managing diabetes today, it makes it even more important for nurses to be fully trained in all aspects of diabetes management allowing them to be more sympathetic, compassionate, and understanding toward their patients. By providing children with medical, physical, and emotional support, nurses will find that they are more effective in their jobs and their patients are more satisfied with the overall coping process 
Developing an Implementation Plan 
Many great ideas died because of poor intervention and poor implementation. The time has come where health care needs to shift from where they are today to the way they need to be. Implementing a new plan require excellent management skills, leadership, staff, data collection, financial, feedback, and time. According to Grand Canyon (2011), “implementation is the presentation of practical means for achieving, and accomplishing research goal” with the right tools, and proper planning produce progress and improvement. For a plan to be successful, the first component is to analysis and understands the effect of the strategic or proposal plan (Ahrens, 2005). It is important to establish the key purpose of the organization so that objectives of the organization and its implementation will align with the key mission (Ahrens, 2005). The author’s purpose for writing this paper is to discuss different component that is a need to be integrated when developing an implementation plan. 
Approval Method and Securing Support for Proposal 
A good implementation plan must seek support and approval from leaders, managers, fellow staffs, and organization’s leaders to be successful and good execution. It is important to protect and support the plan of the proposal. It is important that all members review the main reason for the plan and the reasons for the change. Each member has to contribute generalized knowledge to support the proposal. Before implementation, it is imperative that all members of the group analysis, assesses, and evaluate the core reason for the change and finger mark what each member can contribute to the proposal project. Feedback is important when implementing a plan that proposing a change, it beneficial to provide positive input and accept criticism when implementing changes. 
One of the main stage of a good implementation plan to be successful is a decision-making stage, this stage allows leaders to provide a written memos that summarizing or outlining the sake of the proposal. Clarification of each member’s roles is important in helping the organization growth. Having organizational support is essential for an implementation plan to be successful. Consider what will make each member stick to the plan until all necessary strategies have been proven and tested. Until all the important strategies is tested and proven it is necessary that all members of the group stay with the plan. All organization needs to stay within a nominated budget when present their proposal to the stakeholders, so any proposal that will not exceed their designated budget will most likely be approved. Lastly, making sure that all the necessary elements and questions, focusing on the barriers, a benefit for changes, and going through all the consideration will help secure approval. 
Description of Current Problem 
There are 29.1 million people in America, or 9.3% of our citizens have diabetes, it is a valuable source used by Center for Disease control and prevention” ( pg 48). It provides a background of crucial and valuable information that are supporting diabetes. It gives us an insight, statistical about the burden and stressors that complicate obesity and Type 2 diabetes in U.S.A., especially among Hispanic Community. Diabetes Type 2 is on the rise in the Hispanic community. Patients are suffering from many complications of this disease. Amputation, kidney disease, Gangrene, and cardiovascular diseases are among the most common complications of Type 2 diabetes. “ The need for education, training, and intervention on lifestyle changes in preventing and management of this disease and restoring glucose regulation is of important” (Duggan, 2014).
Many data has collected in preventing and generalized management on diabetes”. However, Diabetes continues to be great concerns in healthcare. The need for more interventions, education, and teaching necessitate in the prevention and manage this disease. Managing Type 2 Diabetes is a multidisciplinary responsibility for all members. Although health cares professionals play a major role in managing this disease. It is of great important to educate and teach their patients, and the community about prevention and management of this disease. Stressors within the Hispanic community are some of the causes of racial and ethnic health disparities have sturdy social etiology. Implementing and providing intervention has emerged as a strategy to reduce or eliminate health disparities. Language barriers, Obesity, lack of education, and cost effective are major stressors that affect patients living, preventing, and managing Type 2 Diabetes. This writer work on a medical, surgical unit sees the hand on the effectiveness and complications and the prevalence of this disease. Implementing change to preventing, managing this disease, and reducing the complications, mortality, cost, and hardship associated with Diabetes Type 2. 
Detailing Explanation of Proposed Solution 
Type 2 Diabetes can be preventive and should be to manage with truculent intervention and implementation plan in place. The writer proposal solution will be to incorporate lifestyle changes, weight -reduction program, self- monitoring of blood glucose, medication regimen. Other solution includes strenuous daily exercise, heart healthy nutritious diet low fat, low cholesterol, calories diet consisted of lots of fruits and vegetables, and diabetes preventive and management programs”. (Ripsin, 2009) Cited that “Evidence –based guidelines for the comprehensive management of diabetes focus primarily on lifestyle changes, management of cardiovascular disease risk factors and management of blood glucose levels”(pg. 29). Complications and treatments in managing Type 2 Diabetes are very costly, increased readmission, and mortality rate increases from patients dying from infections and complications related to Type 2 Diabetes. Knowledge of management and prevention is considered a basic ingredient for nurses as a profession. Finding the best treatment and management is this disease can be very costly and become a burden to patients, family members, hospitals, and insurance companies. 
Rationale for Proposed Solution 
Finding the evidenced-based practice to prevent and manage Type 2 Diabetes is the rationale behind the proposal solution. Meloni, 2013 cited that “Diabetes is connected with a higher risk for adverse cardiovascular outcomes” (pg 14). Collecting data from nurses and patients are excellent ways to received feedback and factual evidence on the process of management and prevention of Type 2 Diabetes. It would be from experienced nursing staff members who work on a medical, surgical unit for clients who are at risk or working with patients who have cardiovascular disease and Diabetes. Some people may argue that the average patients or guardians reported that they monitored their blood glucose level using an Accu-check machine and maintained a healthy lifestyle by eating low-sugar and low-fat diet. The question is how many patients or guardians or healthcare providers can honestly attest to monitoring their sugar on a daily basis before each meal and eating a healthy diet. While we search for an answer, we may not completely know the actuality amount of how often glucose that were monitored. The reality is tracking the progress of a plan to assess, measure, and evaluate a proposed. Goal to enable an implementer makes accommodation and adjustment. 
Evidence 
Monitoring and recording of patients finger sticks prior to each meal, and bedtime has always been the acceptable standard of care in a hospital or healthcare setting. As a nurse, it has always been part of our discharge planning to educate, teach and providing each patient with the right tools in managing and preventing complications of their diseases. According to Meloni, (2013)”The goal is to control and improved glycemia in diabetic patients with reduced cardiovascular risk and complication associated with diabetes. The studies also disclose that decrease HA1C, weight reduction, blood pressure, decrease cholesterol would help in managing diabetes. Maintaining a healthy lifestyle and complying with diabetic treatments can overall increase health lifestyle, decrease complications that can decrease cardiovascular risks and increased patient outcomes” (pg 10). Maintaining a healthy lifestyle exercise, diet, complying and managing blood glucose control and medication such as Metformin has shown a decreased in-hospital stay, cost effective, readmission, decreased complications, and increased patient’s outcome. 
Implementation Logistics 
Not acknowledge ownership to those who carry out a plan is the enormous resistance to change. Acceptance and confidence are essential when implementing a new proposal or plan for any changes. To be successful leaders, staff, and management has to be in participation from start to finish providing support, feedback from everyone on the team is important. It important to be non-judgmental, avoid bias, accepted criticism. It important to make sure that everyone on the team is involved in decision- making of the plan, its problem and its proposed solution is well written and presented to stakeholders. During the proposal, it’s paramount that the need for the change is emphasized, highlighted, well explained, and describe. It significant that we identify those who are for the change and those who resist the change, it also important to recognize those who wait to see, if the proposal was approved or not approved. A proposal or implementation plan should not be considered a competition or cause rivalry but the importance for the changes and how beneficial the outcome of the changes will impact others. Leaders and staff should accept that there are barriers that can smash or influences the plan. Members of the team should remember that all barriers can be solved through assessment, intervention, and evaluation. Proper education, seminars, feedback, and surveys came overcome these stressors or barriers.
Managing and Prevention of Type 2 Diabetes can take a toll on each patient, family member, and the environmental. Diabetes affects everyone in their well-being mentally, physically, emotionally, and spiritually. Lack of support from each member can impact the plan from been implemented. Prevention has always been the cure in solving the problem. It is important for patients to manage this disease efficiently. As healthcare workers, it is of importance that we educated and taught our patients, members of the community, and families about preventing and managing this disease. An implementing several program about managing and preventing this disease is of important and good support groups is essential in implementation planning. The time to take control of this Type 2 Diabetes is now, tracking patient blood glucose, weight reduction program, compliance with a medication regimen, diet, and lifestyle changes. Educating and teaching staffs and patients about better management and preventing this disease. Implementing the use of passport were staff and patients can track the progress of this implementation plan.
Required Resources for Implementation. 
Sufficient staffs, patients, leaders, and family member’s involvement will need for a successful plan. Teaching and Education are the keys ingredient when getting the message across. Using flyers, the internet, seminars, pamphlets, surveys, power point presentation, and questionnaires, 24 hours diabetic hotline, and diabetic programs are efficient for implementing, preventing, and managing type 2 Diabetes. Providing good data, valuable resources, profitable, and using a convincing approach, we can gain the tools and funding approval for the change, cost, education, teaching, and training. Providing staffs with the proper tools, knowledge, education and training will be beneficial when educating patients. Educating patients, family members, and the communities through programs, flyers, or pamphlets is of importance. These tools may or may not increase budgets. During the implementation phase, formulate a means for feedback, criticism, and compliance. When implementing a plan that is beneficial to a job, hospital or better patient outcomes, it is important to gain support from Administration and upper management. Mortality rate are increasing, hospitals, Medicaid, Medicare, and other insurance companies are losing millions and millions of dollars each year in treating the complication of this disease. Therefore, prevention is less costly.. 
Incorporate Theory
The Neuman system model center on the holistic, and the prosperity of each, the theory view each patient as an open system, based on the individual preexisting condition. The individual could be dealing with stressors within the environment. The stressor may be focusing on the five variables that consist of spiritual, physiological, psychological, socio-culture, and developmental (Ume, Nwagbo ET a., 2006). The center core of the open system focuses on individual genetic structure, organ strength, temperature, weakness, response pattern, and commonalities that are ego structure. ( Neuman, 2011)
My proposed solution to the PICOT question is to offer preventive and self-managing measures or interventions in place to control complications, and maintaining a healthy lifestyle associated with Type 2 diabetes. This model stress that a nurse should maintain the Neuman System stability through the use of three levels in managing and prevention of the illness that in existence. The model stresses that nurses accentuate the use of primary, secondary, and tertiary prevention intervention for conquer maintenance, and preservation of the individual well-being in managing and preventing Diabetes type 2. On a special level, the intervention should focus the patient internal and external wellbeing.
One of the paradigms of Neuman system is nursing. Nursing as always being a profession that see each patient as a whole, the center of attention is on the individual, family, and the community. As nurses our goal has always protect, prevention, management, promotion, and provide optimum level of care to our patients. In order any treatment, management and preventative measures to be effective, nurse’s uses the nursing process which include (assessment, diagnosis, planning, and implementation, and evaluation.) as their focus on the Neuman System Model as a tool when integrating primary, secondary, and tertiary prevention. To validity Diabetes Type 2 our most accuracy in detecting diabetes type 2 is hemoglobin A1C; it is use as a screening tool in detecting early onset of Type 2 Diabetes. The HBA1c cut –off point of >6.1%, the normal level range 5.7% to 6.4%. Pre diabetes: 5.7% to 6.4% A study conducted by Duggan C, Carroso, 2014 in Lower Yakima Valley, Washington D.C stated that” participants who received curriculum education about lifestyle changes , Heart healthy diet , physical activities, and diabetic treatment. In comparison with the participants who were not educated and intervention on lifestyle changes”, as nurse we must give great attention the treat each patient as a whole, each intervention and treatment affect each individual emotionally, socially, physically, and mentally.
Retaining this system stability the first step in Neuman Theory is primary prevention, the nurse’s job is to strengthen and protect the flexible line of defense. It is important to educate, train, and provide prevalence information that is patient- centered to each individual. Educating patient and providing vital information on life style changes such as a Healthy nutritious diet, strenuous physical activities, and healthy hygiene avoid skin break, and managing Diabetes Type 2 with oral medication such as Metformin.
Secondary prevention to fortify and support internal lines of resistance, reducing the feedback but increase resistant factors is to focus on the signs and systems of diabetes. Educating, teaching, provide patients knowledge and the tools in maintaining a healthy lifestyle and interventions that gear toward wellness and avoid complications. The secondary prevention aims is to stop the progression of Diabetes type 2 into Insulin dependent Type 1. Some of the preventive measures include follow-up lab work, maintain HBA1c <6.1%. Monitor blood glucose, and increase physical activities and maintaining healthy eating habit combined with vegetables and fruits.
Tertiary prevention is to re-educate, re-adapt, and maintain, stabilized, treat, and promote wellness post treatment to avoid potential re-occurrences. It is of most important to assess, plan, implement interventions, and evaluate the effectiveness of the treatment in managing this disease. Based on the assessment and diagnosis (signs and systoms), nurses must set short or long term goals in managing and preventing complication while promoting wellness? 
Methods to evaluate effectiveness of proposed solution
When one develops a proposed solution, it is always crucial to come up with methods to evaluate effectiveness of the same. It is on this note, that there has been development of methods to evaluate effectiveness of the proposed solution of prevention and management of diabetes type 2. For the methods to be effective, it is crucial that much attention is paid in selection of the methods. One such method is survey of nurses’ attitudes before and after initiating the change. The attitude of the nurses ought to be surveyed before effecting the change. This attempt is meant to ensure perception of the change in attitude that is expected when change has been initiated. The attitudes of the nurses could be surveyed through observation and even interviewing them to get a glimpse of their attitude. Attitude occupies a crucial place when it comes to initiating changes. After initiating change, it is crucial that the attitude of nurses is surveyed so as to ascertain the effect of the change. If the attitude has changed to positive side, then the proposed solution is of positive impact and should be encouraged more and more. If the attitude orient to negative side, then it shows that there is a problem with the proposed solution and the problematic area should be checked for rectification. 
It is crucial that survey is done on the contributors of satisfaction. On this area the concentration need to be on the nurses or the health care provision personnel as well as the patients. To have a successful solution, it is crucial that the parties involved are satisfied. Satisfaction, being a psychological aspect, is not easily noticed. Therefore, it is crucial that the contributors to satisfaction are identified so as to ensure that they are engaged in the process of initiating change. For instance, for nurses to be satisfied in the process of managing and preventing diabetes type 2 there ought to be sufficient equipment for use in the provision of health care service. There should also be efforts to ensure that there is no overworking of the nurses. This is achieved by ensuring adequate staffing and proper working schedules. The patients’ satisfaction could emanate from reception of good care from the healthcare providers. 
The other method touches on survey of patient discharge comparison before and after initiating change. Connelly, Kirk, Masthoff & MacRury (2013) observe that; when the proposed solution is of positive impact, there ought to be higher number of discharges than when the proposed solution was not available (pg. 1420). This follows the ability of the nurses to work harder and post a positive impact especially in quick recovery of the patients hence, more discharge from hospital. On the other hand, if there is less discharging of the patients than before, it means the proposed solution is not working well and therefore, rectification need to be initiated. If there is high number of discharge of patients, it means the proposed solution is working well and should be encouraged more. 
Porterfield, Rogers, Glasgow & Beitsch (2015) note that; in the evaluation of prevention and management of diabetes type 2, it is crucial to bear in mind the various variables involved. Nurses’ attitudes and perceptions are variable number one that must be given a lot of attention. The nurses (as well as the other involved health care providers) ought to have a positive attitude and perception towards prevention and management of diabetes type 2 in order to achieve success. The nurses ought to have the right attitudes and perceptions geared towards understanding that they have a duty to prevent and manage diabetes type 2. The notion of duty here is not meant to mean so much work rather it should be tinged with a calling notion where by the nurses and the other healthcare providers take it as their call and noble work to prevent and manage diabetes type 2. With this kind of attitude and perception, it becomes easy for the healthcare providers to give their all in the efforts of preventing and managing this ailment. With their undivided effort, it becomes easy to achieve the stipulated target of preventing and managing the disease in the best way possible. Patient attitude and perception is a crucial variable in the proposed solution of prevention and management of diabetes type 2. Duggan (2014) asserts that; it is important that patients have the right attitude especially towards the nurses and the medicine given. This way, they are able to cooperate with nurses in the efforts to prevent and manage diabetes type 2. Hamidreza Khosravizizade (2014) discloses that; the attitude of the patients could also be associated with the support they get from their families. Therefore, their attitude is not entirely tied on the nurses. 
To achieve success in the efforts of preventing and managing diabetes type 2, it is crucial to have tools of educating the involved parties. Questionnaires with questions such as: what do you understand by diabetes type2? What is your attitude towards its management? Such would go a long way in educating the nurses and the patients because their perception will be known. Surveying the patients and the nurses in the hospital would also go a long way in getting a perception of their attitude deliberations and therefore, know where more education needs to be given. 
Disseminating Evidence
The word disseminating means a set of planned actions designed to empower and promote incorporation and application of validated strategies.” To assist in developing these approaches, we created a practical framework drawn from the literature on dissemination and our experiences disseminating evidence-based practices” (Harris, 2012). The purpose of dissemination can be to make awareness of the project or proposal, or make action by those who can use the result to effect changes within the organization making outcome of the result accessible to stakeholder and their audience. (Turpin and Harmsworth, 2000). The results of the health care project are normally disseminated to provider, employers, payers and clients about prevention and management of diabetes type 2. The results of the professional capstone project about managing and preventing type 2 diabetes. The outcome will be dissimilated to the key stake holders. The stake holders for this project are CEO of the hospital, Director of Medicine, Director of Medical-Surgical units, Nurses Educators, Director of Diabetic Clinic, and Evidence –based practice committee, Nurse Managers, Director of research department, and mainly our patients and their families.
Dissimilar methods of dissemination will be use for diverse stakeholders because their information needs are different. Successful dissemination connects the recipients in a development to increase awareness, commitment, understanding, and their action (Turpin, 2000). The project will be presented to through power point presentation that are accessible to all key stakeholders, e-mails, news bulletins, conferences, media, websites, workshops, interviews, and staff meeting. These offer the advantage of communication among the stake holder. Financial consideration will be given to the cost of disseminating information.
A mailing list, phone numbers, and email addresses of diabetic patients their family, and the communities who are high risk paying close attention to Hispanic residents. Patients who are managing and preventing this disease based on their medical records will be managed and received update through the use of a phone, mailing newsletters, and emails to them. For the hospitalized clients and their families’ one to one conference will be used to update and discuss result. Flyers and brochures will be given. The key stake holders will informed through the use of reports, workshops, seminars, conferences, reports, newsletters, and emails. These advance communication will be used to dissemination the result to hospital CEO, and health care professionals. Power point presentation will be used when presenting update and results at the workshops, conference, and seminars, Handouts, brochures, and fact sheets will be disseminated. . Individual meeting will be held with interdisciplinary groups.
The results will be published in Nursing professional journals, nursing monthly meeting, and national nursing professional organizations, Local newsletters, newspapers , and nursing unions will present these results at workshops, and conferences organized by local, state, and nurses nationwide. Setting up interviews with the media, and journalists who are working for medical and nursing healthcare professional organization is essential in getting the message across. The use of websites makes the results virtually available to all the key stakeholders, patients, nursing community, and general public. 
The stakeholders who participated and worked on this project will be cooperative and supportive in formulating the most effective dissemination strategies and implementing this plan to ensure the success and victory surrounding this proposal or project. As nurses our goal has always to implement a plan that is beneficial and promote optimal health to each patient. Dissemination is successful when managing and preventing diabetes type 2 when patients treatment intervention has change in response to the project. The acceptable project results of diabetes type 2 prevention and management interventions were clearly stated and appropriate.
CONCLUSION:
Review of Literature
Janet Lewis
Grand Canyon University: Professional Capstone Project
Professor: Gray
May 22, 2015
Many data has collected in preventing and generalized management on diabetes. However, Diabetes continues to be great concerns in healthcare. The need for more interventions, education, and teaching necessitate to be done in the prevention and manage this disease. 
The author purpose of this paper is to appraise, analyze and review the fifteen literature and articles identified for the PICOT question that focus on management and prevention of diabetes. The PICOT question: (P) Does the management, treatment and prevention method work for patients newly diagnosis Type 2 Diabetes in Hispanic? (I) Manage, treat, prevent, decreased complications of diabetes, and hemoglobin A1C. (C) Compare those patients who implement dietary and healthy lifestyles with those who do not (O) prevent and manage Type 2 Diabetes and reduce hemoglobin A1C (T) Time- frame) three months after primary diagnosis. The paper will be the center on providing answers to the explicitly critical appraisal questions. The focus would be “What is the sample size? Why was the study prepared? Are the tools of the major reliable and variables valid or facts without bias?
The first step in managing and preventing the predominance of type 2 diabetes is to identify the patients who are at risks of developing this disease. In 2008, Gabriel Q, Shaibi, Ph.D. performed a qualitative study of Hispanic Youth, who are overweight and are high risk for developing metabolic syndrome. The study uses a sample size of 218 overweight Hispanic children who has a family history of type 2 diabetes. The metabolic syndrome shows that three or more were noted with abdominal obesity, elevated blood pressure, hyperglycemia, and high cholesterol. Results show that Hispanic youth with metabolic syndrome has sixty percent lower sensitivity compared to Hispanic, who is not at risk. This study defined that there is a need for interventions in managing and preventing type 2 Diabetes.
In 2007, Rhodes, Scott D, Ph.D., MPH, A qualitative systematic reviews with the growing trends of diabetes increasing among Hispanic in children and adults. In the total of 172 studies lay health advisor provide incense various issues within the Hispanic community because many causes of racial and ethnic health disparities have sturdy social etiology. Implementing and providing intervention has emerged as a strategy to reduce or eliminate health disparities. Participants who meet the criteria gather members of the community that can provide prevalence information and advocate for the communities and data collected about the disparities such as health promotion and disease prevention, prenatal health, and Cardiovascular prevention. Result shows that the “LHA approaches could be important to understand the harness that is affect the Hispanic communities, based on the research reveals that there are resources and ways to improve the health and well-being of members of the Hispanic community”( Rhodes D ,2007). Providing healthy programs in the community about prevention and management of diseases that affecting the community, this intervention has emerged as a strategy to reduce or eliminate health disparities.
Diabetes Type 2 is on the rise in the Hispanic community, and the need for education, training, and intervention on lifestyle changes in preventing this disease and restoring glucose regulation is of important (Duggan, C, Carroso E, 2014)
Qualitative information / data collected from men and women who have a hemoglobin A1C over level higher than 6% randomized trial conducted from 2008-2012 survey was conducted and collected on participant in Lower Yakima Valley in Washington D.C, who received curriculum education about lifestyle changes , Heart healthy diet , physical activities, and diabetic treatment. In comparison with the other participants who goes on to live a regular life without education intervention on lifestyle changes. The sample size consisted of N=320 N=166 received immediate education and n=154 delayed education intervention. (Duggan, C, 2014), S“With lifestyle changes and education on diabetic treatment, incorporating fruits, vegetables, mild to moderate physical exercise over three to six months. After six months, period participants was given a questionnaire and blood sample. The result shows that there was a significant reduction in Hemoglobin A1C”. (Duggan, C, 2014). In clinical practice, it is important to educate our patients and the public about the importance of lifestyle changes, healthy diet, and moderate strenuous exercise and complying with diabetic treatments.
In 2014, scientific data and statistics report 29.1 million people in America or 9.3% of our citizens have diabetes. It is a valuable source from Center of disease control and prevention. It provides a background of crucial and valuable information that supporting the subject (diabetes) at hand. It gives us an insight, statistical about the burden obesity and Type 2 diabetes in U.S.A.
In 2007, the A study was conducted by Martha Raidl, Ph.D.; RD found that there were major challenges that affect the management of diabetes. The study found that people living in nonurban areas are given less education, meal planning and lifestyle changes in management this disease. In Idaho incidence of diabetes has shown an increased from 4% in 1997 to 6.2% in 2004. With diabetes increasing among a nonurban population such as Colorado, Idaho, and Oregon creating an interest, and demand for diabetic education was of important. The quantitative study was conduct in three urban and five rural counties in Idaho. Four sessions was held in provide participants with healthy diabetic meal planning, change eating habits that include fruits and vegetables, and diabetic education. Results shows that health diabetic curriculum was effective, the gain more knowledge about managing diabetes after managing for three years. 
Nurses’ knowledge, training, and education play an important role in management and prevention of diabetes. A qualitative study was conducted to assess nursing student discerning and the difficulty of diabetes management. Misunderstanding or bias about the complexity of managing diabetes among health providers can have a negative effect on client’s satisfaction and outcomes. Subthemes of gaining an appreciation for those who live with diabetes included having sympathy and compassion for clients related to complying/not complying with the treatment regimen. Undergraduate students did study, and nurse practitioner for one week in self-management of diabetes, Participants were sent home with instruction to make dietary changes, eat a balanced meal, monitor glucose levels, and self-manage an insulin pump and incorporated into their daily lifestyle. How integrated these tasks or tools in their lifestyle affect them mentality, physical, or emotional. The result shows that living with diabetes can be a challenging. Participants get insight on understanding the stress, lifestyle changes, and inconvenience of living with diabetes. Nurses learned more to have compassion, sympathy, and be considerate with patients who are living with diabetes.
Improving diabetes management and prevention of type 2 diabetes is essential; a study was conducted in 2013, by Okenrik Duru MD, MSHS. A health plan was put in place to help the client in preventing and managing diabetes. This program is gear to helping pre-diabetic clients or clients who are diabetic. The diabetic plan guides and provides clients excellent access that assist with managing and preventing this disease. Participants age 45-64yrs communicate via internet access or telephone coaching and case management with vital information that assist them with managing their medication and diabetes. The study was conducted by members of the University of California, and United Health Care to analysis and collect data about how effective is the Diabetic Health Plan. The result shows that the plan was very effective, diabetic complications decreases low cost for diabetic medications, decrease co-payments, fewer readmissions, and patients’ outcome improved. It is essential that all health-care professional especially nurses received effective training, knowledge, and education. It will be valuable and successful in providing education on prevention and management of this disease. In the end everyone benefit especially patient outcome.
Diabetes Type 2 continues to affect millions of people in America. The important of good support among family members is fundamental. A randomized control study was conducted on 91 patients from the outpatient clinic. It was conducted by Hamidreza Khosravizade Tabasi1 (2014). The purpose of the study to show how a family support impact patient with type 2 diabetes. Intervention groups were given education classes in administering diabetic medications and cognition in type2 diabetes. Both the intervention groups and control groups were given questionnaires to evaluate how effective the support groups in comparison to the control group over a three months. Measurements and variables result shows the intervention groups, shows Hemoglobin A1C by 89.1% reduction from clients who received family support. Results also show clients who occasional forgetting to take medication, and a significant reduction from 91.1% to 22.2%. Likewise, feeling stressed about sticking to treatment plan show 4.5% reduction. The important of family intervention and support is significant in managing and preventing type 2 diabetes. No correlation showed among the control group. It indicated and addressed family who largely impact on the persons who are distress from Diabetes, for both children and adult. 
It is important how healthcare professions manage health and diseases without been bias.
This article is relevant to this specific topic at hand, it articles addresses alternative, CAM, and complementary medicine that nurses, parents of children with diabetes, or caregiver may practice different options in managing and preventing any illness .Diabetes type 2 been one of them and it important how each manages this disease. It important for healthcare professions to educate patients, caregivers, and family members about the different option that fit each need. 
Finding the best treatment and management is this disease can be very costly and become a burden to patients, family members, hospitals, and insurance companies. In a study conducted by Michael Brandle about how expensive it is to treat Type 2 Diabetes. We studied a random sample of 1,364 participants in surveys, members of health maintenance organization in Michigan with type 2 diabetes. Diabetes treatments diabetic treatments/ complication, blood sugar control, and co-morbidities Result shows that the average cost for women who are controlling her diabetes without medication cost $2100 for white men %1700. A patient who are on oral diabetic medication and have other complication or illness such as Hypertension and BMI over 20% cost increase cost by 60%-90%. With the reformed Act gearing toward primary care, it is very important that nurses and healthcare professions to educate provide training, and the tools and skills to their patients and the public in preventing and manage Type 2 Diabetes. Preventing complications associated with diabetes with show a significant decrease in readmission/hospital stay, cost effective for both the patients, hospitals, insurance companies such as Medicare/Medicaid. In the end patients outcome increases and mortality rate decreased.
The need to address the emotional aspect of coping with diabetes is of important in coping and living with diabetes. I find that it is of most imperative to concentrate on the technical approach , Diabetes is associated with a higher risk for adverse cardiovascular outcomes. In a study conducted by Meloni, A. R.,(2013). Collected data analyze over a 26 weeks in four clinical trials, provide interventions and how effective glycemic control with the use of medication such as oral diabetic medication( Metformin), Sitagliptin a glucagon-like peptide-1 (GLP-1) receptor agonist, and plants over a 1 week trial. The goal is to control and improved glycemic in diabetic patients with reduced cardiovascular risk and complication associated with diabetes. Studies disclose HA1C decreases, weight reduction, blood pressure, and cholesterol were decreased. Maintaining a healthy lifestyle and complying with diabetic treatments can overall increase health, decrease complications that can decrease cardiovascular risks and increased patient outcomes. Healthcare professions must ensure that all patients received facts, evidenced-based, and patient -centered information. Nurses should make certain patients received skills, training, and education about complications, stressors, and importance of controlling diabetes.
A study in 2009 preform by Wallach A recent study of 2,681 New York City elementary school children revealed that 24% are obese, and another 19% are overweight. Wide discrepancies exist in the prevalence of diabetes among ethnicities and also by sex among Hispanics. Hispanic boys have obesity rates that are significantly higher than those for Hispanic girls (36% vs. 26%) .Further aggravating this situation, Hispanic school children, who make up 40% of the students, have experienced the rapidest rise in obesity. My approach to address, these need the school-based nutritional diet, and more physical activities will decrease obesity, decrease complication such as heart disease, respiratory disease, and mortality rate. (Wallach, 2009)
To be sure, some of these critiques are totalistic, do not always align with empirical evidence and, in revealing the limits of professionalism, also succeed in masking the benefits of professionalism captured by earlier trait and functionalist contributors (Saks 2014). It is important that all data are fact and evidenced based, this was an interesting critique which I thought would be valuable for reconnoiter the responsive/emotional characteristics of diabetes and how adult and children may better handle manage lifestyle .changes. “The loss of a self-supporting professional mechanism of expert peer control based on members’ subscriptions could also carry heavy financial replacement costs for government, further increase bureaucracy, and eliminate a useful buffer between individuals and the state (Stacey, 2013)” thereby it is of most that nurses are trained and knowledge in educating children and adult in coping and changes associated with diabetes.
Wong conducted a systematic reviewed Ca, Cummings GG (2013) Io examine the relationship between patient satisfaction, outcomes, and nursing leadership. After a 20 studies satisfied our inclusion criteria and were retained with nurse feeling and complaining of burnout, fatigue, nurse’s shortage, baby boomers retiring. It is important that patient safety, satisfaction, and patient outcomes are our priority. Nurse leaders should provide a safe atmosphere avoid medication errors, address nurse shortage, Implementing policies and procedures to avoid hospital acquire infection, Leadership lower patient mortalities, and increased patient outcomes and management must ensure that each patient get the best care, right tools, skills, training, and education in manage their diseases or illness in a safe environment and post discharge. Since in today society, patient safety remain a great concern in hospitals. Hospital-acquired Infections, falls, and complications related to numerous diseases such as diabetes and heart diseases. 
Nurse’s organizations continue to research, collecting and evaluating survey and data on ways to improve patient’s satisfaction and patient outcome.
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Preventing Chronic Disease 2012; 9110081.DOI:http://dx(dot)doi(dot)org/10.5888/pcd9.11008
Retrieved from http://www(dot)cdc(dot)gov/Other/disclaimer.html
I want to start by telling you that I can clearly see a difference in your writing skills from Week 1 until now, that being said, your paper lacks clarity. You mention every single dissemination method available but do not relate it to your project specifically. All of those are great methods, publishing in a research journal, news media, but are you doing that for your project results? They do not apply to your project. For your final paper, I would like to see you pick one or two methods and clearly state how you will use them in your project! There are still many grammar mistakes but I am proud of much you have grown in your writing