Management of type 2 Diabetes in Primary Care and how Nurse Practitioners are well Suited for this Task

Management of type 2 Diabetes in Primary Care and how Nurse Practitioners are well Suited for this Task

Management of type 2 Diabetes in Primary Care and how Nurse Practitioners are well Suited for this Task

Research Paper Outline

• Nurse practitioners (NPs) are considered primary care providers in most states and play a role in managing Type 2 diabetes (T2DM) patients.
• Research topic: Management of type 2 diabetes in primary care.
• Initial research question: How are nurse practitioners well-suited to managing Type 2 diabetes in primary care?
• The research paper will examine if NPs have the knowledge, skills, and attitude needed to manage patients with T2DM in primary care settings.
• Initial thesis: NPs are adequately trained in managing patients with chronic illnesses, particularly diabetes. They have vast experience managing T2DM from class and clinical experience when they learn the pharmacological and non-pharmacological approaches to T2DM and how to provide patient education. Therefore, they are well-suited to provide T2DM care to patients in primary care settings.
  

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Development Questions

• What training do NPs undergo to equip them with knowledge and skills in managing T2DM?
• What factors make NPs suitable for managing T2DM in primary care settings?
• To what degree can NPs provide care to T2DM patients based on the NP’s scope of practice?
• What are the advantages of NPs providing T2DM management in primary care compared to primary care physicians?
• What challenges can NPs face when delivering care to patients with T2DM?

Interest in the Topic/Significance of the Topic

• Many people with T2DM receive their primary care from non-physician clinicians like NPs.
• The trend can be attributed to a reduced number of primary care physicians (Guo et al., 2020).
• Besides, the widening rural-urban disparity in the distribution of physicians and the increasing healthcare costs makes more patients seek services from non-physician clinicians.
• In light of these changes, it is essential to examine how NPs are well-suited to manage patients with T2DM.
• It is also important to evaluate if there are differences in the processes and outcomes when NPs deliver care.

Keywords

The keywords that will help in the search for scholarly articles include:

• Nurse practitioner
• Primary care
• Type 2 Diabetes mellitus

Potential Sources

• Crowe, M., Jones, V., Stone, M. A., & Coe, G. (2019). The clinical effectiveness of nursing models of diabetes care: a synthesis of the evidence. International Journal of Nursing Studies, 93, 119-128. https://doi.org/10.1016/j.ijnurstu.2019.03.004
• Everett, C. M., Morgan, P., Smith, V. A., Woolson, S., Edelman, D., Hendrix, C. C., … & Jackson, G. L. (2019). Primary care provider type: Are there differences in patients’ intermediate diabetes outcomes? Journal of the American Academy of PAs, 32(6), 36-42. doi: 10.1097/01.JAA.0000558239.06875.0b
• Muench, U., Guo, C., Thomas, C., & Perloff, J. (2019). Medication adherence, costs, and ER visits of nurse practitioner and primary care physician patients: evidence from three cohorts of Medicare beneficiaries. Health Services Research, 54(1), 187-197. https://doi.org/10.1111/1475-6773.13059
• Yang, Y., Long, Q., Jackson, S. L., Rhee, M. K., Tomolo, A., Olson, D., & Phillips, L. S. (2018). Nurse practitioners, physician assistants, and physicians are comparable in managing the first five years of diabetes. The American Journal of Medicine, 131(3), 276-283. https://doi.org/10.1016/j.amjmed.2017.08.026

Problems or Complications

The challenges that I encountered when refining my question and finding sources include:

• Uncertainty on whether to examine Diabetes management in general or be specific to T2DM.
• Insufficient articles that examine NPs’ suitability in managing T2DM.
• Limited articles examining NPs’ education preparation for managing diabetes.
• Insufficient US articles examining how NPs provide care to diabetic patients in the primary care setting.

References

Crowe, M., Jones, V., Stone, M. A., & Coe, G. (2019). The clinical effectiveness of nursing models of diabetes care: a synthesis of the evidence. International Journal of Nursing Studies, 93, 119-128. https://doi.org/10.1016/j.ijnurstu.2019.03.004

Everett, C. M., Morgan, P., Smith, V. A., Woolson, S., Edelman, D., Hendrix, C. C., … & Jackson, G. L. (2019). Primary care provider type: Are there differences in patients’ intermediate diabetes outcomes? Journal of the American Academy of PAs, 32(6), 36-42. doi: 10.1097/01.JAA.0000558239.06875.0b

Guo, F., Lin, Y. L., Raji, M., Leonard, B., Chou, L. N., & Kuo, Y. F. (2020). Processes and outcomes of diabetes mellitus care by different types of team primary care models. PloS one, 15(11), e0241516. https://doi.org/10.1371/journal.pone.0241516

Muench, U., Guo, C., Thomas, C., & Perloff, J. (2019). Medication adherence, costs, and ER visits of nurse practitioner and primary care physician patients: evidence from three cohorts of Medicare beneficiaries. Health Services Research, 54(1), 187-197. https://doi.org/10.1111/1475-6773.13059

Yang, Y., Long, Q., Jackson, S. L., Rhee, M. K., Tomolo, A., Olson, D., & Phillips, L. S. (2018). Nurse practitioners, physician assistants, and physicians are comparable in managing the first five years of diabetes. The American Journal of Medicine, 131(3), 276-283. https://doi.org/10.1016/j.amjmed.2017.08.026

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Final Research Paper:
Current Trends/Issues for the Nurse Practitioner

Overview:
o Students will identify a current trend or issue that impacts the role or practice of the Adult-Gerontological Nurse Practitioner
o You will write a five-page research paper in APA format describing a current issue or topic that impacts practice for AG PCNP’s
o APA format includes: Title Page, 12-pt font, double-spacing, proper in-text and reference page citations, proper formatted headings
o Your paper must have at least 5 scholarly sources other than the textbook, published in the past 5 years. In addition to these 5 sources, you can also cite the textbook, non-scholarly sources, and sources >5 years old.
o You may include your opinion in your paper if you choose
o All work is to be submitted through Canvas and assessed for plagiarism
o There are seven steps in the development of your paper and the paper presentation
I. Topic submission
II. Research Paper Outline submission
III. Research Paper Outline Peer Review
IV. Research Paper 1st draft submission
V. Research Paper 1st draft Peer Review
VI. Final Research Paper submission
VII. Research Paper Presentation
o The Final Research Paper is worth 25% of your grade
o The Presentation of your Final Paper is worth 5% of your grade
o Research Paper Grading Rubric follows

Research Paper Rubric
Criteria Unsatisfactory – Beginning Developing Accomplished Exemplary Total
Paper Focus:
Purpose/
Position Statement
0-13 points 14-15 points 16-17 points 18-20 points /20
Fails to identify a relevant research topic or is not clearly defined and/or the paper lacks focus throughout. Current issue is poorly defined, and/or not convincingly related to AGPCNP practice. Identifies a research topic but may be too broad in scope and/or the thesis is somewhat unclear and needs to be developed further. Focal point is not consistently maintained throughout the paper. Current issue is not well defined, and/or not convincingly and rigorously related to AGPCNP practice. Identifies a relevant research topic and a thesis that provides adequate direction for the paper with some degree of interest for the reader. The thesis states a relevant current issue and explains its impact on AGPCNP practice; focus is mostly maintained throughout the paper. Identifies a relevant research topic and a thesis that provides direction for the paper that is engaging and thought provoking, The thesis clearly and concisely states a relevant current issue and explains its impact on AGPCNP practice; focus is consistently maintained throughout the paper.
Analysis
0-22 points 21-23 points 24-26 points 27-30 points /30
Demonstrates a lack of understanding and inadequate analysis of the research topic and thesis. Demonstrates general understanding with limited critical analysis of the research topic and thesis (argument). Demonstrates an understanding and some critical analysis of the research topic and thesis (argument). Demonstrates a sophisticated understanding and careful, critical analysis of the research topic and thesis (argument). Draws original and thoughtful conclusions with future implications.
Evidence (Sources)
0-22 points 21-23 points 24-26 points 27-30 points /30
Lacks sufficient research sources to support the central position and/or, if included, are generally not relevant, accurate, or reliable. Contains numerous factual mistakes, omissions, or oversimplifications. Sources, if included, are not properly referenced, and cited in the paper. Provides some evidence to support the central position with only a few research sources. Some sources may not be relevant, accurate, and reliable and/or appropriately referenced and cited in the paper. Provides essential, accurate evidence to support the central position with the required (5) scholarly research sources from the past 5 years that are mostly relevant, accurate, and reliable. Sources are referenced and cited appropriately throughout the paper for the most part. Provides compelling and accurate evidence to support in-depth the central position. Research sources are highly relevant, accurate, and reliable and add to the strength of the paper and are effectively referenced and cited throughout the paper.

Organization
0-6 points 7 points 8 points 9-10 points /10
Paper lacks logical organization, impeding readers’ comprehension of ideas. Central position is rarely evident from paragraph to paragraph and/or the paper is missing multiple required components. Paper is somewhat organized, although occasionally ideas from paragraph to paragraph may not flow well and/or connect to the central position or be clear as a whole. May be missing a required component and/or components may be less than complete. Paper is adequately organized. Ideas are arranged reasonably with a progression of thought from paragraph to paragraph connecting to the central position. Includes required components (introduction, body, conclusion, references, etc.) for the most part. Paper is effectively organized. Ideas are arranged logically, flow smoothly, with a strong progression of thought from paragraph to paragraph connecting to the central position. Includes all required components (introduction, body, conclusion, references, etc.).
Writing Quality & Adherence to Format Guidelines 0-6 points 7 points 8 points 9-10 points /10
Paper significantly deviates from proper APA guidelines. Frequent errors in spelling, grammar, punctuation, spelling, usage, and/or formatting. Length is significantly shorter than 5 pages. Paper follows APA guidelines to an extent. Some errors in spelling, grammar, punctuation, usage, and/or formatting. Length shorter than 5 pages. Paper follows APA guidelines. Minor errors in grammar, punctuation, spelling, usage, and/or formatting. Length is 5 pages. Paper is well written and clear, using APA guidelines. Basically free from grammar, punctuation, spelling, usage, or formatting errors. Length is 5 pages.
TOTAL POINTS (sum of 5 criteria) /100

Adapted 10/2019 from Rubric by Denise Kreiger, Instructional Design and Technology Services, SC&I, Rutgers University, 4/2014

Steps in the Development of Your Paper
Step I. Topic Submission: Faculty approval is required prior to beginning to write your paper
o Submit your topic for your final research paper by stated due date
o Here you will describe your topic in 1-2 sentences. Be as specific as possible to make the paper more focused and easier for you to write.
o Do some background research BEFORE submitting your topic, so you know what your topic is and how it impacts practice.
o Put your topic something like this: “My paper will discuss…”
 Examples of topics: Nurse practitioner fellowships/residencies (looking at a specific aspect of these or their impact); improving breast cancer screening access for Black and African American women; COVID testing protocols; improving clinicians’ ability to distinguish alcohol abuse in older adults; effectiveness or practicality of a newer diabetes medication or injection equipment; specific psychosocial screening (e.g. complex PTSD, intimate partner violence) in the primary care setting; or primary care interventions and adequate sleep in a population.
 If you’re stuck for a topic idea, I recommend looking at what is being discussed in current journals for nurse practitioners and other primary care providers. Here are some links to journals:
https://www.npjournal.org/
https://journals.sagepub.com/home/ggm
http://www.jfmpc.com/currentissue.asp?sabs=n
https://www.jabfm.org/
o Once you submit, I’m going to give you feedback on your topic to make sure it’s specific enough that you can reasonably address it in five pages.
Step II. Research Paper Outline Submission
• An outline is very helpful in the development of a research paper. You are asked to develop an outline of your research paper.
• The following guidelines and resources may be helpful to you and were adapted from:
Katie Duveneck, Hunter College
• Submit your outline by the stated due date
• Once submitted, each outline will go through a peer review process where your outline will be reviewed by an assigned student colleague. The purpose of a peer review process is to provide further insight and critique to promote quality as your paper develops.

Research Paper Outline Steps and Checklist

Read through Research Paper Guidance document
Identify your topic
Identify your initial research question
Identify your initial thesis
Create at least 5 development questions
Explain why you are interested in the topic/ significance of topic
List keywords
Locate 4 potential sources
Name your challenges so far
Complete your outline
Peer review outlines during class

Using Your Thesis
There are many ways to structure a research paper. It is up to you how to structure yours. If you’d like guidance, I recommend using a traditional thesis-based structure.
Structure it around your thesis (answer to your research question) and development questions. For instance, if my research question is “What are the main practice challenges facing AGPCNP’s who prescribe MAT (medication assisted treatment) for opioid dependence?” my paper might include a thesis answering my research questions, such as:
Thesis: The main practice challenges facing AGPCNP’s who prescribe MAT (medication assisted treatment) for opioid dependence are poverty, the frustrating nature of addiction, and the NP’s own expectations.
The thesis should go at the end of the introductory paragraph.
If you are worried about getting to 5 pages, using your development questions can be very helpful. By the time you answer all your development questions (with support from your sources and your own analysis), you’ll probably find that you have no trouble reaching 5 pages.

Using Development Questions to Develop Your Paper
1. What is your research question? This is the question you will be exploring in your research. What do you want to know or discover about the topic you have chosen? As you go through the research process your research question may change, and that is fine.
Example: How can AGPCNP’s use screening tools to identify elder abuse in the outpatient setting?
2. Write at least five “development questions.” These are questions that underlie your research question (must be answered in order to answer your research question) or arise from your research question. They can be simple or complex questions.
o Development questions are questions that underlie or arise from your research question. That is, they are questions that you need to answer to answer your research question, or that grow out of your research question.
o Development questions can help think of different directions to take your paper. Every paper will be different, depending on your interests, your topic, and what you discover in your sources.
o Some questions are more theoretical and abstract (such as how or why questions), while others are more concrete and practical (such as questions about policy implications).
o Some people like to structure their paper around their development questions (and their answers). You may find that you don’t use all of them, but only some of them. One of them may even become your new research question.
3. Why are you interested in this topic? Why is this topic important?

4. List some keywords that you can use to search for additional scholarly sources.
5. Locate 4 potential sources. They don’t have to be perfect – these are just 4 sources that might work.
6. What problems or complications have you run into, if any? This can be anything – limiting your scope, refining your question, finding sources… anything!
7. Here are some examples of development questions
 In the above example, questions that underlie my research question might be:
o “Are screening tools used to identify elder abuse in the outpatient setting?”
o “Which if any screening tools are evidence-based and recommended
o “Is identification something that needs to be improved?”
o “Does identification correlate with improved patient outcomes? If so, which outcomes?”
 Questions that arise from my research question might be:
○ “Is incorporating elder abuse screeners into the EHR software an effective strategy for improving screening?
○ “What are the barriers to NP’s making referrals?”
○ “What if any legal reporting requirements exist in NY State relative to elder abuse?”
○ “What actions are recommended, and by whom, when the NP is concerned that elder abuse is occurring?”

Research Paper Outline

An outline template is below. You are welcome to use it, but you are not required to – you can create your outline however you prefer to do it. Your outline must contain the following:

● State your “working thesis” (your answer to your research question, based on your analysis of your sources). This may change as you write your paper – that is fine.

● A basic outline of the structure of your paper – you don’t have to write any of your paper; this can just be bullet points, if you like.

● In your outline, indicate where you will use your sources, and give specific citations (quotes or paraphrases) you plan to use. There should be at least 1 citation from each of your sources in your outline (at least 2 sources, more if you have more) and a minimum of 5 citations total (they don’t have to be divided evenly between your sources – it’s normal to use some sources more than others).

Research Paper Outline Template

1. Introduction (Page 1)
● “Hook”
● Identify your topic
● Your working thesis (your answer to your research question, based on your analysis of your sources)

2. Background and context (Page 1)
● It may help to use development questions to explain background/context of issue

3. Body paragraphs (Pages 2 through 4 or 5)
● Use development questions to guide your research and guide the logic of your paper
● First sentence of each paragraph should tie in with the previous paragraph (“smooth transitions”)
● Cite sources with quotations and/or paraphrasing

6. Conclusion (Page 5)
● Restate your thesis (your answer to your research question)
● Answer the question, “so what?” Why does this matter?
● Optionally, include your personal reason/s for selecting this topic

Adapted October 2020 from Katie Duveneck, Hunter College

Step III. Research Paper Outline Peer Review
• The following outline will be used during the outline peer review process.
• Adapted October 2020 from Katie Duveneck, Hunter College

Research Paper Outline Peer Review

Reviewer: As a peer reviewer, your job is to help this writer envision the future direction of their paper. As you read and discuss, write down all your comments, questions, and suggestions to give to your partner afterwards. Answer any of the following questions and any others the author would like you to address. As you discuss the paper, both reviewer and author should continue making notes on it.

Author: Tell your partner what part/s you feel most confident about and what part/s you want help with. (Help on structure? Use of sources? Limiting scope? Other? General feedback?)
GENERAL
● Strengths: What is going well?
● What area needs the most work, and what ideas do you have to develop it?
● What question/s do you hope the paper will answer?
● What was your biggest takeaway?

SCOPE
● Is the scope limited enough, or still a bit broad? Do you have ideas for narrowing it down?

SOURCES
● How many, if any, scholarly sources have been cited so far?
● Will these sources help your partner answer their research question?
● What other suggestions for sources do you have?
● Has the author started to build their own analysis based on the sources?
RESEARCH QUESTION AND ARGUMENT
● Point to the author’s research question. If it’s not given, write down what you think it is.
● Does the thesis statement sum up the author’s answer to their research question?
● How might the thesis be strengthened? Give specific suggestions.
● Based only on the reading the outline (not what the author says aloud), describe in one sentence how this topic relates to the AGPCNP role.
● Identify where the author states the exigence of their argument (why it matters).
● Are there counter-arguments you think should be addressed?

STRUCTURE
● Does the structure make sense? If not, give ideas to improve it.
● Are there gaps in the argument or missing pieces? What do you think should go there?
● Is there anything touched on briefly that you want to know more about?

Step IV. Research Paper Draft Submission
• After careful review of comments from the peer-review process student will submit the first draft of their paper
Step V. Research Paper First Draft Peer Review
• This first draft will also go through a peer review process using the following guidelines:

Research Paper First Draft Peer Review

Reviewer: As a peer reviewer, your job is to help this writer envision the future direction of their paper. As you read and discuss, write down all your comments, questions, and suggestions to give to your partner afterwards. Answer any of the following questions and any others the author would like you to address. As you discuss the paper, both reviewer and author should continue making notes on it.

Author: Tell your partner what part/s you feel most confident about and what part/s you want help with. (Help on structure? Use of sources? Limiting scope? Other? General feedback?)
GENERAL
● Strengths: What is going well?
● What area needs the most work, and what ideas do you have to develop it?
● What question/s do you hope the paper will answer?
● What was your biggest takeaway?

SCOPE
● Is the scope limited enough, or still a bit broad? Do you have ideas for narrowing it down?

SOURCES
● How many, if any, scholarly sources have been cited so far?
● Will these sources help your partner answer their research question?
● What other suggestions for sources do you have?
● Has the author started to build their own analysis based on the sources?
RESEARCH QUESTION AND ARGUMENT
● Point to the author’s research question. If it’s not given, write down what you think it is.
● Does the thesis statement sum up the author’s answer to their research question?
● How might the thesis be strengthened? Give specific suggestions.
● Based only on the reading the draft (not what the author says aloud), describe in one sentence how this topic relates to the AGPCNP role.
● Identify where the author states the exigence of their argument (why it matters).
● Are there counter-arguments you think should be addressed?

STRUCTURE
● Does the structure make sense? If not, give ideas to improve it.
● Are there gaps in the argument or missing pieces? What do you think should go there?
● Are there smooth and logical transitions between paragraphs?

Adapted October 2020 from Katie Duveneck, Hunter College

Step VI. Final Research Paper Submission
• After careful review and revision student will submit their final research paper by the due date

Step VII. Research Paper Presentation
• Each student will develop and present their research paper with the class
• Guidelines:
o Discuss your research paper with the class
o Develop a PowerPoint slide show presentation which:
○ Explains what your paper states (without reading it word for word)
○ You may include your opinion/s and why you chose your topic if you want to
○ Time allocation: adhere to approximately 5 minutes (no less then 3 min and no more than 7 min)
• Presentation Grading Rubric:

Component of Presentation Value
Time Adherence to 5 minutes (no less then 3 or mor than 7) 25%
Engagement Easy for audience to pay attention (does not read word for word from research paper) 255
Organization Ideas presented in a logical order 25%
Relevance What is presented is relevant to the research and what is written in the paper 25%
100%