This document discusses the implementation of a diabetes self-management education program (DSMES) in a primary care setting. The plan is to educate diabetic patients over 9 weeks using the DSMES program and evaluate fasting blood sugar levels before and after. The implementation plan was changed so that each topic of the DSMES program is taught on a different day rather than all at once. This change was necessary to help patients better understand and retain the information. The stakeholder engagement process has begun by identifying nurses to provide the education, though some patients withdrew from the study and needed replacing. The implementation is ready to begin once all resources are in place.

1. [From 10$/Pg] Large Pragmatic Study Involving
[From 10$/Pg] Large Pragmatic Study Involving PICOT: “In adult patients with diabetes in a
primary care outpatient setting, will implementation of the DSMES program, compared to
current practice, impact fasting blood sugar within 8-10 weeks?”1- How you are going to
ensure achievement of these milestones? The change project will comply with the Plan-Do-
Study-Act (PDSA) cycle model. These steps require nurses to plan their change, implement
it, assess its impact, and sustain it. The implementation schedule will take nine weeks,
which should involve educating diabetic patients using the DSMES program before the
evaluation in the last week. The change process has four milestones, and the educational
intervention has ten milestones. The change process milestones will be achieved
systematically, beginning with the planning stage to the action stage. According to Coury et
al. (2017), the planning stage usually involves preparing for change by having necessary
stakeholders, creating the project’s aim, and having the needed resources. Therefore, all the
stakeholders and resources, such as nurses, diabetic patients, and educational materials,
including the objectives to be addressed, should be drafted before proceeding to the
implementation stage. The implementation stage should be feasible if the resources in the
planning stage are availed. The analysis is always done based on the results of the actions
(Coury et al., 2017). Thus, it can be convenient if the ‘Do’ stage is well done. Finally, an
action is taken based on the outcomes of the study stage (Coury et al., 2017). In this case, it
will be done when the action stage is complete. As for the implementation, preparatory
analysis of the DSMES topics before each week can facilitate the completion of the
educational intervention. Overall, the change process and implementation milestones can
only be achieved well when adequate preparation is done during the planning stage,
including ensuring that patients, nurses, and educational materials are available before the
project.2-How has your plan for implementation changed, if at all? The
implementation plan changed to ensure that each subtopic of the DSMES program is taught
each day. For instance, the program has various topics, including drug adherence, healthy
nutrition, diabetes management, and physical activity (Goff et al., 2021). Each topic will be
tackled each day to ensure that patients understand everything by the end of the
educational program.3-Why were these changes necessary? These changes were
necessary since patients would forget the information and fail to comply. According to
Naylor and Torres (2019), learning objectives are significant as they help students learn
what they should do and can assist in designing more effective instruction. In this project,
designing more effective instruction using the general DSMES program would be unfeasible.

2. For this reason, each topic was selected to create a more practical learning program. For
instance, when learning about nutrition, patients will understand different foods and their
significance in controlling blood sugar. When learning about physical activity, they will be
taught moderate exercises and instances where they may need vigorous physical activity.
Overall, changes were necessary to make the educational process convenient.4-Have you
started implementation? I am yet to start the implementation since I have just finished
organizing the stakeholders. The DSMES program is effective when implemented by nurses
(Kashani et al., 2020). Thus, I have worked on getting nurses who will educate patients. I am
set to begin the implementation process the next week. With the availability of the
stakeholders, the process will be completed well.Successes, Challenges, or Barriers The
implementation process is currently in the first stage of reorganizing resources. I have
identified all the resources needed to be utilized in the project. The success was getting
nurses willing to educate patients since nurses efficiently deliver patient education
(Fereidouni et al., 2019). The only challenge was getting all patients to agree since some
withdrew from the project, and I had to replace them. The language barrier was the only
barrier witnessed while engaging patients. Overall, the project is set to begin since all the
resources are available.ReferencesCoury, J., Schneider, J. L., Rivelli, J. S., Petrik, A. F., Seibel,
E., D’Agostini, B., Taplin, S. H., Green, B. B., & Coronado, G. D. (2017). Applying the plan-do-
study-act (PDSA) approach to a large pragmatic study involving safety net clinics. BMC
Health Services Research, 17(1), 411. https://doi.org/10.1186/s12913-017-2364-3 (Links
to an external site.)Fereidouni, Z., Sabet Sarvestani, R., Hariri, G., Kuhpaye, S. A., Amirkhani,
M., & Kalyani, M. N. (2019). Moving into action: The master key to patient education. The
Journal of Nursing Research: JNR, 27(1), 1–8.
https://doi.org/10.1097/jnr.0000000000000280 (Links to an external site.)Goff, L. M.,
Rivas, C., Moore, A., Beckley-Hoelscher, N., Reid, F., & Harding, S. (2021). Healthy eating and
active lifestyles for diabetes (HEAL-D), a culturally tailored self-management education and
support program for type 2 diabetes in black-British adults: A randomized controlled
feasibility trial. BMJ Open Diabetes Research & Care, 9(1), e002438.
https://doi.org/10.1136/bmjdrc-2021-002438 (Links to an external site.)Kashani, F.,
Abazari, P., & Haghani, F. (2020). Challenges and strategies of needs assessment
implementing in diabetes self-management education in Iran: A qualitative study. Iranian
Journal of Nursing and Midwifery Research, 25(5), 437–443.
https://doi.org/10.4103/ijnmr.IJNMR_10_20 (Links to an external site.)Naylor, K. A., &
Torres, K. C. (2019). Translation of learning objectives in medical education using high-and
low-fidelity simulation: Learners’ perspectives. Journal of Taibah University Medical
Sciences, 14(6), 481–487. https://doi.org/10.1016/j.jtumed.2019.10.006 (Links to an
external site.)Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H.,
Maryniuk, M. D., Siminerio, L., & Vivian, E. (2016). Diabetes self-management education and
support in type 2 diabetes: A joint position statement of the american diabetes association,
the American Association of Diabetes Educators, and the Academy of Nutrition and
Dietetics. Clinical Diabetes, 34(2), 70–80. https://doi.org/10.2337/diaclin.34.2.70ABOUT
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