Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Sandra Cleveland

Abstract

Problem:

Type 2 Diabetes Mellitus is a common chronic illness with far-reaching health and financial consequences. At the project’s primary care clinic, the average hemoglobin A1c among adults with Type 2 Diabetes Mellitus was 9.6%, exceeding the recommended clinical goal of less than 7% (American Diabetes Association, 2023). The absence of a standardized follow-up protocol and inconsistent use of health literacy-based communication contributed to persistent hyperglycemia and failure to reach target HbA1c levels. These factors indicated an urgent need for an evidence-based intervention.

Aim of the Project:
The aim of this project was to reduce HbA1c levels among adults with Type 2 Diabetes Mellitus to the target range of 6.5%–8.5% by implementing a nurse-led, standardized follow-up phone call protocol. The intervention was designed to address medication adherence barriers, reinforce patient self-management, and enable timely response for uncontrolled blood glucose.

Review of the Evidence:
Substantial evidence supports nurse-led structured follow-up and health literacy-informed communication for improving glycemic outcomes in adults with Type 2 Diabetes Mellitus. Randomized controlled trials and meta-analyses show significant reductions in hemoglobin A1c when teach-back, structured follow-up, and tailored education are used (Moreira et al., 2024; American Diabetes Association, 2023).

Project Design:
A quality improvement approach, guided by the Plan-Do-Study-Act framework, allowed for iterative refinement of the protocol. The OhioHealth Change Management Model supported staff engagement, leadership commitment, and long-term sustainability.

Intervention:
Eligible adults with Type 2 Diabetes Mellitus and hemoglobin A1c levels greater than 8.5% received four structured nurse-led follow-up phone calls over twelve weeks. Nurses used the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit: Tool 6 – Follow-Up with Patients (Agency for Healthcare Research and Quality, n.d.) to guide each call, focusing on medication adherence, self-monitoring of blood glucose, diet, and symptom management.

Significant Findings/Outcomes:
The project resulted in a mean hemoglobin A1c reduction of 1.67%, with a post-intervention average of 7.93%. Approximately 62% of participants achieved the target HbA1c range of 6.5%–8.5%. Nurse adherence to the protocol was 82.3%, and documentation compliance was 63.8%. No safety events were reported. Staff expressed increased confidence and noted improved workflow.

Implications for Nursing:
This project illustrates the value of advanced practice nurses leading quality improvement initiatives using health literacy strategies. The protocol is a sustainable, evidence-based solution to reduce disparities and address care gaps for adults with Type 2 Diabetes Mellitus.

Rights

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